Spravato treatment centers and ketamine clinics
Spravato Billing for Esketamine and Ketamine Clinics
Medtransic handles Spravato billing for esketamine and ketamine clinics. We check each patient's benefits, request prior authorization where a plan requires it, and send a claim for every supervised session to Medicare or the commercial plan, inside SimplePractice, TherapyNotes or the system you already use. For ketamine, we check the plan first so you can tell patients up front what to expect. Billing is 4-8% of what we collect for you. There is no long-term contract.
Spravato induction, twice a week
IllustrativeOne supervised session, one claim, one monitoring form
- Billing
- 4-8%
- of what we collect for you
- Credentialing
- $150
- per application, per provider
- Contract
- None
- no long-term contract
- Tracking
- Live
- every claim and application in your portal
Where a Spravato clinic loses money
Every session carries REMS paperwork and a billing rule set by the payer and the drug supply route.
Wrong Medicare codes for the supply route
Medicare's bundled session codes apply only when the supervising professional supplies the drug. If a pharmacy delivers the patient's own drug, CMS says bill office visit and prolonged-service codes instead.
A second visit billed on session day
CMS says a separate office visit with the session codes is duplicative, because they already include the visit and observation. Visits on other days can still be billed.
Claims built on a deleted drug code
On January 1, 2026, CMS replaced the temporary esketamine code with a permanent one and deleted the old code. Fee schedules and claim templates built on it need updating.
The drug billed on top of a session
For Medicare, the esketamine is a supply inside the bundled session code. CMS says it cannot be billed separately with those codes.
A missing monitoring form
The REMS requires a Patient Monitoring Form within 7 calendar days after every session. A late or missing form leaves that session out of step with the REMS.
What Medtransic runs and what your clinic keeps
Medtransic runs
- Benefits checks before the first session, for Spravato and ketamine
- Prior authorization requests where the patient's plan requires them
- Tracking approval dates and sessions used, so treatment does not outrun the approval
- A claim for each session, set up for the payer and supply route
- Payment posting, denials, appeals and follow-up on unpaid claims
- Credentialing for your prescribers with Medicare and commercial payers
Your practice keeps
- REMS certification of the clinic and enrollment of each patient
- The Patient Monitoring Form after every session, filed within 7 days
- Clinical care, dosing decisions and the 2-hour observation
- How you obtain the drug, and your self-pay prices for ketamine
What the Spravato REMS asks of your clinic
Spravato (esketamine) is a Schedule III nasal spray sold only through a restricted FDA program, the Spravato REMS. FDA last changed the REMS on June 24, 2026.
Clinic certification
Certified pharmacies may dispense Spravato only to certified settings, so the clinic must be certified. It needs a prescriber on site during dosing and monitoring, monitoring staff and a pulse oximeter.
Patient enrollment and a check before every dose
Each outpatient is enrolled before treatment starts. The clinic confirms enrollment before every dose.
What the monitoring form records
It records the dose, the lot number and the total monitoring time, with a reason if that was under 2 hours. It also asks whether vital signs and pulse oximetry were acceptable, and about any serious adverse event.
At least 2 hours of observation
The patient uses the nasal spray under a provider's direct supervision, then is watched for at least 2 hours, including pulse oximetry. Blood pressure is checked before the dose and again at about 40 minutes.
Records, audits and no take-home doses
The clinic records every shipment and every dose, and must allow audits by the manufacturer or a third party. It may not dispense the drug for use outside a certified setting.
Two ways to get the drug
A REMS-certified pharmacy can deliver a patient's own drug on a patient-specific prescription, or you can buy bulk supply from a REMS-qualified distributor. For Medicare, the route decides the codes.
Dose and schedule
Each device delivers 28 mg, so a 56 mg dose uses 2 devices and an 84 mg dose uses 3. For treatment-resistant depression the label sets doses twice a week for weeks 1 to 4, weekly for weeks 5 to 8, then weekly or every 2 weeks.
Getting a Spravato clinic ready to bill
A claim is paid only once the clinic, prescriber, patient and plan are each in place.
Clinic certified in the REMS
Certification comes first, because certified pharmacies may only send Spravato to certified clinics.
Prescribers credentialed with each payer
We credential your psychiatrists and other prescribers with Medicare and the commercial plans you want to take.
Benefits checked, approval on file
Before the first session we check the patient's plan and request prior authorization where that plan's current policy requires it.
Patient enrolled in the REMS
Your clinic enrolls the patient before the first dose and confirms enrollment again before every dose.
A claim after each session
For Medicare we bill the session code for the dose given, or visit and prolonged-service codes when a pharmacy supplied the drug.
How payers treat Spravato and ketamine
For Medicare the drug supply route decides the codes, and each commercial plan sets its own rules.
| Payer or drug | The rule | What we do |
|---|---|---|
| Medicare, clinic supplies the drug | One of two bundled session codes: up to 56 mg, or more than 56 mg. Each covers the visit, supervised self-administration, 2 hours of observation and the drug. | We bill the session code that matches the dose given. |
| Medicare, pharmacy supplies the drug | The bundled session codes cannot be used. CMS says the visit and observation are billed with office visit and prolonged-service codes. | We set up each patient's claims to match the supply route. |
| Medicare, the 2026 drug code | Since January 1, 2026, a permanent per-milligram code replaced the temporary one. Medicare lists it as not covered on its physician fee schedule. | We update your claim set-up and fee schedule to match. |
| Commercial plans | Each plan publishes its own Spravato policy and decides how the drug and session are billed. | We check the current policy before the first session and request approval where required. |
| Ketamine | FDA states that ketamine is not approved for any psychiatric disorder. Its approved use is as an anesthetic. | We check each patient's plan first, so you know whether to plan for self-pay. |
Your client portal, included
Your EHR shows what you billed. Your portal shows what we are doing about it.
Your EHR or practice management system runs your practice, but it does not show you our work. The Medtransic HIPAA Compliant Portal does: every claim and its current stage, the denials we are working, your A/R by age, each payer application and its in-network date, and the documents we still need from you. It is the same record our team works from, and it comes with every client account.
- Did that claim get paid?
- Every claim with its stage and amount, the denials we're working, and your receivables by age.
- Where is my application with Aetna?
- Each payer application shows its stage, its history, and the date you can start seeing that payer's patients.
- What do you still need from me?
- One list of the documents we're waiting on. Upload once, and it reaches every payer that asked for it.
When another option suits you better
- If your clinic offers only ketamine and never bills insurance, you may not need a billing company. A clear written self-pay policy may be all you need.
- If your clinic is not yet certified in the Spravato REMS, start there. REMS enrollment and the monitoring forms are completed by your clinic.
Questions Spravato and ketamine clinics ask us
How does Medicare pay for a Spravato session?
When your clinic supplies the drug, Medicare pays one bundled code per session for the visit, the drug and 2 hours of observation. There are two levels: up to 56 mg, and more than 56 mg. A separate office visit on the same day would be duplicative.
What if a pharmacy delivers the patient's Spravato?
Then the bundled Medicare session codes cannot be used. CMS says the visit and the observation are billed with ordinary office visit and prolonged-service codes. We set up each patient's claims to match the supply route.
What changed for Spravato billing in 2026?
On January 1, 2026, CMS replaced the temporary per-milligram code for esketamine with a permanent drug code. Medicare lists the new code as not covered on its physician fee schedule and pays through the bundled session codes instead.
What does the REMS require after each session?
At least 2 hours of observation, including pulse oximetry, then a Patient Monitoring Form filed within 7 calendar days. The form records the dose, lot number, monitoring time and whether vital signs were acceptable.
Is ketamine approved for depression?
No. FDA states that ketamine is not approved for any psychiatric disorder, and Spravato (esketamine) is the approved product for depression. We check each patient's plan first so you know whether to plan for self-pay.
Can a patient take Spravato home?
No. It is given only in a REMS-certified healthcare setting under direct supervision, and the clinic may not dispense it for use outside that setting.
What does Medtransic charge a Spravato or ketamine clinic?
Billing is 4-8% of collections, with no long-term contract. Credentialing is $150 per application, per provider. The consultation before you sign is free.
Keep reading
- Psychiatry billing and credentialing →
- Prior authorization →
- Mental and behavioral health billing services →
- Credentialing →
- TMS clinic billing →
- PMHNP practice billing →
- PMHNP credentialing →
- Mental health IOP and PHP billing →
- Pricing →
+ − Sources: 11 checked 2026-10-04
- FDA, SPRAVATO (esketamine) nasal spray Prescribing Information (revised 04/2025), checked 2026-10-04
- FDA, Spravato REMS modification approval letter (June 24, 2026), checked 2026-10-04
- FDA, REMS@FDA, Spravato REMS, checked 2026-10-04
- Spravato REMS, Outpatient Healthcare Setting Enrollment Form (FDA copy, June 24, 2026), checked 2026-10-04
- Spravato REMS, Patient Monitoring Form (FDA copy, June 24, 2026), checked 2026-10-04
- Federal Register, CY 2020 Physician Fee Schedule final rule (November 15, 2019), checked 2026-10-04
- Federal Register, CY 2021 Physician Fee Schedule final rule (December 28, 2020), checked 2026-10-04
- CMS, 2026 Physician Fee Schedule relative value files, October update, checked 2026-10-04
- CMS, HCPCS application summary, Quarter 3 2025, drugs and biologicals, checked 2026-10-04
- CMS, January 2026 Integrated Outpatient Code Editor update, checked 2026-10-04
- FDA, warning letter to ketaminetroches.com (June 23, 2026), checked 2026-10-04
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