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Billing Guidance for Spravato® Nasal Spray

Wednesday, May 3, 2023

Spravato® (esketamine) nasal spray is a limited benefit under TRICARE for beneficiaries ages 18 years and older who have been diagnosed with treatment-resistant depression. 

Centers for Medicare & Medicaid Services Billing Guidelines

TRICARE follows the Centers for Medicare & Medicaid Services (CMS) billing guidelines for Spravato, which specify use of HCPCS codes G2082-G2083 rather than E/M codes. Per the American Medical Association, both G2082 and G2083 encompass the office visit, drug purchase, drug administration, and post-administration observation services. 

HCPCS Code J3490 No Longer Accepted

We recognize some providers include HCPCS code J3490 with a nominal charge ($0.01) for administrative purposes. Per TRICARE policy, Health Net Federal Services, LLC (HNFS) may not reimburse for HCPCS code J3490 on Spravato claims, as providers are to buy-and-bill under HCPCS codes G2082 or G2083 only. Note: HNFS will only reimburse claims submitted by providers who have administered the drug. We will not accept Spravato claims submitted by pharmacy providers.

As a reminder, providers may not bill solely for Spravato (HCPCS code S0013), as payment for the drug is included in G2082 and G2083 reimbursement. 

Pre-Authorization Requirements

Pre-authorization is required for all TRICARE beneficiaries. When submitting a pre-authorization request for Spravato, in lieu of clinical documentation, we strongly encourage prescribing providers to attach our Letter of Attestation available at our Letters of Attestation page. This will help expedite the review process and ensure all clinical requirements have been met. 

For additional benefit details, please visit our Spravato page. For more information on CMS billing guidelines, refer to p. 12 of the Spravato Access & Reimbursement Guide available in the “SPRAVATO® Access” section at
www.SPRAVATOhcp.com/clinical-resources#Janssen_CarePath