Spravato® billing involves REMS requirements, buy-and-bill coding, drug wastage tracking, time-based codes, and strict payer documentation guidelines. Finnastra manages the full cycle to prevent delays, denials, and underpayments.
Under buy-and-bill, you purchase Spravato® and bill the payer using J3490 or S0013 with the appropriate NDC, units, and acquisition cost. Finnastra ensures all required details are submitted for maximum reimbursement.
Payers typically require clinical notes, prior medication failures, PHQ-9 scores, DSM-5 diagnosis codes (like F33.2), and medical justification. Finnastra builds custom templates to ensure each PA request is payer-compliant and audit-ready.
Finnastra maintains a prior authorization approval rate of over 98% for Spravato® by submitting payer-specific documentation, tracking medication history, and proactively following up with insurers. Our precision reduces delays and ensures patients start treatment without unnecessary interruptions.
Our typical turnaround time for Spravato® prior authorizations is just 2–5 business days. Finnastra’s dedicated team submits complete documentation up front and follows up daily to ensure fast approvals and minimal treatment delays.
From credentialing and buy-and-bill setup to coding, prior auths, and ongoing reimbursement tracking, we provide end-to-end support. Our clients typically experience faster approvals, fewer denials, and optimized ROI from day one.
Yes. In addition to billing, Finnastra handles complete credentialing and payer contracting, including setting up buy-and-bill arrangements for Spravato®. We ensure your clinic is properly enrolled and contracted with payers to receive timely and compliant reimbursement.
Most payers ask for
(1) proof of treatment-resistant depression diagnosis (e.g., F33.2 or F32.2),
(2) failure of two oral antidepressants,
(3) REMS enrollment confirmation, and
(4) The planned HCPCS/NDC pairing.
Finnastra assembles these elements into a payer-specific PA packet and tracks renewals so authorizations don’t lapse.
Each state Medicaid and Medicare program has unique reimbursement policies. Finnastra works directly with state and federal guidelines to ensure accurate NDC formatting, PA handling, and time- based coding to get you paid.
If any portion of a single-dose vial is unused and discarded, In Finnastra we bill the administered amount normally and report the discarded amount on a separate claim line using the JW modifier. This ensures compliance with Medicare and commercial payer requirements for drug wastage documentation. Finnastra handles JW reporting automatically to prevent denials or audit triggers.
Clinics purchase Spravato upfront, then seek reimbursement 30-60 days later. If the acquisition cost (WAC + shipping) exceeds payer reimbursement, every treatment erodes margin. Finnastra reconciles each remit against acquisition cost and flags any under-reimbursed units so you stay cash-positive.
Track
(a) first-pass denial rate (goal < 5 %),
(b) days-to-payment (goal < 30 days),
(c) net collection ratio per dose, and
(d) prior-auth approval turnaround.
Finnastra’s monthly profitability dashboard highlights these KPIs so you can expand Spravato services confidently.
Same-day claim submission, fully populated NDC/HCPCS pairs, and electronic attachments of REMS logs are key. Finnastra pushes claims daily and uses electronic medical-record hooks to attach monitoring notes automatically, driving payments in as little as 14 days with some payers.
Spravato billing sits at the intersection of REMS safety rules, buy-and-bill drug inventory, and dose-specific HCPCS codes (G2082 & G2083). Missing any element such as the REMS-certification attestation, the correct NDC, or the two-hour monitoring note triggers payer edits and denials. Finnastra’s 98 % first-pass approval workflow checks every requirement before submission, dramatically reducing denial risk.
Only REMS-certified prescribers and sites can administer Spravato, and documentation of on-site monitoring (120–180 minutes) must accompany each claim. Missing REMS evidence leads to denials or post-payment audits. Finnastra embeds REMS checkpoints directly in your EHR workflow.
No. CMS and most commercial payers prohibit separate psychotherapy billing during the monitored Spravato session because the G-code already bundles provider supervision time. Scheduling therapy after monitoring ends (on a new encounter) avoids duplicate-billing flags.
Not at all. Finnastra works seamlessly with all major EHR and PM systems, including Osmind, AdvancedMD, Kareo, eClinicalWorks, Athenahealth, and more. Our experienced team adapts to your existing platform—no need to change systems or disrupt your workflow.
We have extensive experience billing Medicare, Medicaid, BCBS, Aetna, Humana, UHC, Cigna, and other major commercial payers. Our team understands each payer’s unique coding, documentation, and reimbursement guidelines, ensuring accurate claims and faster payments.
Spravato® is an FDA-approved, intranasal esketamine administered under a REMS program for treatment-resistant depression, while IV ketamine is an off-label infusion not approved by the FDA for depression. Only Spravato® can be billed to insurance, and Finnastra specializes in navigating its complex billing and compliance requirements.
