Can You Bill 96132, 96138, or 90867–90869 With Spravato®?

Understanding CPT Code Combinations for Spravato®, Mental Health, and TMS Billing

Spravato® (esketamine) treatment is becoming a vital tool for patients with treatment-resistant depression, PTSD, and other complex mental health conditions. However, billing for Spravato® can be confusing—especially when trying to combine it with other services like neuropsychological testing (96132, 96138) or TMS-related codes (90867–90869).

Many practices ask:

• “Can we bill 96132 and 96138 on the same day as Spravato®?”
• “Can we submit 90867 on the same day as Spravato® treatment?”

Getting these answers right is critical to avoid claim denials, compliance issues, and revenue loss. At Finnastra, a leading Spravato Billing Company, we specialize in helping practices navigate these challenges. Below is a breakdown of what you need to know.

Understanding the Codes

Before looking at how these codes interact with Spravato®, let’s define each category:

• Spravato® Treatment Codes (Buy & Bill Model):
  • Typically billed under HCPCS code J2315 for the drug itself,
  • And CPT 96372 / G2082 / G2083 for the administration and observation services.
• 96132 & 96138 – Neuropsychological Testing:
  • 96132: Neuropsychological testing evaluation by physician or qualified health professional, per hour of testing interpretation.
  • 96138: Administration and scoring of neuropsychological tests by technician, per 30 minutes.
• 90867–90869 – TMS Treatment Codes:
  • 90867: Initial TMS treatment planning.
  • 90868: Subsequent TMS treatment delivery & management.
  • 90869: Subsequent TMS treatment with re-determination of treatment parameters.

Can You Bill 96132 and 96138 With Spravato®?

Yes, but with strict limitations.

You can bill neuropsychological testing (96132, 96138) on the same day as Spravato® treatment, but not on the same claim. CMS and most commercial payers require these services to be billed separately, and documentation must clearly demonstrate that:

1. The services were distinct and non-overlapping.
   • Neuropsych testing must be separate from the Spravato® monitoring session.
2. The provider or staff performing the services is different (if applicable).
   • The person administering the Spravato® cannot be the same one performing the neuropsych testing at the same time.
3. Clear time tracking is documented.
   • For example, if the Spravato® session was 9:00–10:30 am, and neuropsych testing occurred 11:00 am–12:30 pm, this must be explicitly noted in the clinical documentation.

Important: Some payers will still deny these claims even when billed separately unless specific modifiers (e.g., Modifier 59) are used to indicate separate services.

At Finnastra, our team ensures all documentation, modifiers, and claim submissions are audit-proof and compliant, reducing the risk of denials.

Can You Bill 90867 on the Same Day as Spravato®?

This is where things get tricky.

Spravato® treatment and TMS planning codes (90867) are both considered major behavioral health services. Most payers view these as overlapping services and will deny claims when billed on the same date of service.

Here’s why:

• 90867 represents a significant time-based planning and management activity.
• Spravato® treatment codes (G2082 or G2083) include bundled observation and management services.

Because of this, payers typically interpret them as duplicate services unless there’s a very clear and compelling clinical reason—and even then, pre-authorization is often required.

Best Practices to Avoid Denials:

1. Avoid billing 90867 on the same day as Spravato® unless absolutely necessary.
2. If same-day billing is unavoidable:
   • Use appropriate modifiers (Modifier 59 or Modifier 25, depending on payer rules).
   • Include clear documentation justifying the clinical necessity of both services.
   • Submit separate claims to reduce denial risk.
3. Consider scheduling TMS planning and Spravato® initiation on different dates whenever possible.

Why This Matters: Compliance and Revenue Protection

Incorrectly billing these codes together can lead to:

• Claim denials, delaying reimbursement for weeks or months.
• Post-payment audits, especially for REMS-regulated treatments like Spravato®.
• Potential fines or penalties for non-compliance if a payer determines services were “double-billed.”

For buy-and-bill clinics, the stakes are even higher. When Spravato® medication is purchased upfront, denied claims create inventory risk and financial instability.

How Finnastra Helps You Bill Correctly

As a specialized Spravato Billing Company, Finnastra ensures every claim is compliant, accurate, and optimized for maximum reimbursement.

Here’s how we protect your practice:

• Separate claim strategy: We submit 96132 and 96138 claims separately with correct modifiers to meet payer requirements.
• Pre-billing audits: Every claim is checked for compliance before submission, preventing costly rejections.
• Authorization expertise: Our team handles prior authorizations for Spravato®, TMS, and related services.
• Revenue reporting: Transparent reporting lets you track every dollar and identify growth opportunities.

Real-World Example: Avoiding a $25,000 Loss

A midwestern behavioral health practice billed 90867 and G2083 on the same day for 15 patients.

• Result: 100% of claims denied, leading to a $25,000 cash flow crisis.
• After partnering with Finnastra, we:
  • Implemented proper scheduling and modifier strategies,
  • Corrected documentation gaps,
  • And recovered 92% of previously denied claims through expert appeals.

Key Takeaways

• 96132 & 96138: Can be billed the same day as Spravato®, but only on separate claims with distinct documentation and modifiers.
• 90867: Generally not recommended to bill the same day as Spravato® unless clinically justified and pre-approved.
• Always use clear time tracking, separate documentation, and payer-specific rules to avoid denials.

Partner With Finnastra for Spravato®, Mental Health, and TMS Billing

Spravato® billing is highly specialized, and even small mistakes can lead to lost revenue or compliance risks.
When you work with a dedicated Spravato Billing Company like Finnastra, you gain:

• Expertise in Spravato®, TMS, and ketamine billing.
• Seamless prior authorization management.
• A 98% claim pass rate backed by proven processes.
• Confidence that every claim is audit-proof and fully compliant.

Don’t leave your revenue to chance.
Contact Finnastra today and let us simplify your billing process so you can focus on patient care.

Learn more: Spravato Billing Services