Spravato and the REMS
FDA requires Spravato to be dispensed and given in REMS-certified settings that monitor patients for at least two hours after each dose. The record should show the dose, the observation period, and the supervising clinician.
Spravato claims bundle a visit, a drug, and observation
Esketamine nasal spray is given in certified settings with at least two hours of monitoring, and payers disagree on how to code the drug and the visit. Ketamine for depression is a different story, since it is not FDA approved for psychiatric use. Taiga works with mental health practices and will tell you plainly which parts of this work fit its billing model.
Book a demoTwo very different billing paths
Practices that offer both treatments need to keep them apart from intake onward.
G codes or separate drug codes
For Medicare, G2082 and G2083 combine the visit, the observation, and the drug, split at 56 mg. Some commercial and Medicaid plans ask for the drug and the professional service on separate lines instead.
Ketamine outside an FDA indication
FDA states that ketamine is not approved for any psychiatric disorder, and compounded versions have no approved indications. Expect limited coverage and plan for clear self-pay pricing on those services.
Where the line falls
Treatment choices and REMS compliance stay with your clinicians.
Kept in-house
REMS enrollment, dose records, monitoring notes, and approval of each code before submission.
Handled by Taiga
Eligibility checks, claim scrubbing and submission, patient statements, and work on every denial and appeal for the insured services.
Decided together
Settle whether you buy and bill the drug or use a specialty pharmacy, who tracks prior authorizations, and how self-pay ketamine services are kept off insurance claims.
Questions for an esketamine fit call
De-identified treatment logs are the most useful examples. The booking form should not include patient details.
How do you acquire esketamine?
Explain whether the practice purchases the drug or a pharmacy supplies it, since that changes which codes you can bill.
Which payers use which codes?
List your plans and whether each accepts the Medicare G codes or wants separate drug and visit lines.
What runs as self-pay?
Describe any ketamine services you offer outside insurance and how patients are quoted before treatment.
Who this fits
Psychiatry and interventional mental health practices that bill Spravato to insurance and want each session followed to payment. The first claim goes out about two weeks after onboarding begins.
One honest limit
Payer coding rules for esketamine keep shifting, and off-label ketamine coverage is rare. This page explains the claim structure and does not promise payment for any treatment.
Questions about Spravato and ketamine billing
Can Taiga bill Spravato sessions?
Esketamine treatment falls within mental health care, which Taiga supports. Bring your payer list and drug acquisition model so the team can confirm the workflow.
What is the difference between G2082 and G2083?
Both describe an established patient visit with supervised esketamine self-administration and two hours of observation. G2082 covers up to 56 mg, and G2083 covers more than 56 mg.
Do all payers accept the esketamine G codes?
No. CMS created them for Medicare, and some commercial and Medicaid plans have asked providers to bill the drug and the service separately. Check each plan's current policy.
Will insurance pay for IV ketamine for depression?
Coverage is uncommon because FDA has not approved ketamine for any psychiatric disorder. Confirm with each payer and give self-pay patients a clear estimate up front.
Show Taiga your treatment mix
Share how you deliver esketamine and ketamine and which payers you bill. You will get a direct answer on fit.
System guides show possible billing handoffs, not proven specialty compatibility.