Spravato has become a critical treatment option for patients with treatment-resistant depression, but its billing structure remains one of the most complex in behavioral health. As we enter 2026, payer expectations are higher, documentation rules are tighter, and coding errors continue to be the leading cause of claim denials in Spravato programs nationwide.
If your clinic is still experiencing inconsistent reimbursement, unexplained underpayments, or recurring denials, the issue is rarely clinical, it’s almost always tied to front-end billing workflows.
This updated 2026 guide breaks down exactly how to bill Spravato the right way, step by step, with the clarity and operational precision your practice needs. And throughout this guide, you’ll see how a dedicated Spravato Billing Services Company like Finnastra can help you streamline your workflows, eliminate denials, and maximize reimbursement.
Spravato claims follow a uniquely strict pathway. From REMS compliance to Prior Authorization to Buy & Bill, every stage requires precision. Yet more than 32% of Spravato claims are denied on the first submission, according to 2025 behavioral health billing benchmarks.
And here’s the real issue:
Are you confident your team is using the updated 2026 codes?
Are your REMS monitoring notes detailed enough?
Are your PAs perfectly aligned with payer treatment timelines?
If even one answer gives you pause, the revenue risk is real.
Accurate CPT and HCPCS coding is the backbone of clean claims. In 2026, payers are enforcing more stringent code-to-documentation alignment.
Even a small mismatch—like the wrong NDC or insufficient monitoring notes, can trigger an audit or a 30–45 day processing delay.
Our Spravato Billing Services are designed to simplify these complexities by ensuring every claim is fully compliant before it ever reaches your payer.
Still stuck with claims reduced for “non-covered services”? Eligibility gaps are why.
Spravato benefits vary dramatically by payer, plan type, and patient tier. A single oversight can lead to thousands lost in a single week.
When you work with a dedicated Spravato Billing Services Company like Finnastra, your verification process becomes a structured, multi-step checkpoint that catches issues early.
PA delays remain one of the most costly bottlenecks in Spravato programs.
More approvals now require escalation-level documentation, not generic progress notes.
Finnastra handles this by creating audit-ready PA packets that include full clinical narratives, updated scoring metrics, and REMS documentation to accelerate approval timelines and reduce risks of denials.
REMS is a non-negotiable. Payers are now cross-referencing:
Any missing detail, no matter how small, can move a claim directly into denial.
As a leading Spravato Billing Services Company, Finnastra ensures all REMS documentation meets 2026 standards, protecting both compliance and reimbursement.
This streamlined process reflects what high-performing Spravato clinics use today:
Verify coverage, PA requirements, visit limits, and SpravatoWithMe eligibility.
Submit clinical justification, failed treatments, PHQ-9, REMS confirmation, and treatment plan.
Align notes with CPT/HCPCS requirements and induction/maintenance phases.
Apply correct codes, NDC, rendering provider, place of service, and observation times.
Submit claims cleanly with all necessary attachments, narratives, and REMS logs.
Follow payer-specific appeal pathways within 24–48 hours of a denial.
Reconcile payments, monitor payer trends, and escalate underpayments.
Finastra manages this entire workflow end-to-end, allowing your clinical team to stay fully focused on patient care.
Across Spravato, Ketamine, and TMS practices, Finnastra consistently delivers:
These results become possible because we eliminate errors before they reach your payer.
If the answer to any question is uncertain, your practice is likely losing revenue unnecessarily.
When you work with a dedicated Spravato Billing Services Company like Finnastra, you gain a full RCM team built specifically for Spravato, Ketamine, and TMS programs.
All with the goal of stabilizing and maximizing your reimbursement cycle.
Explore how we can support your program here: https://finnastra.com/spravato-billing/
