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.

Last reviewed 2026-10-04.

Where a Spravato clinic loses money

Every Spravato session carries REMS paperwork, a long observation and a billing rule that depends on the payer and on who supplied the drug. Most lost revenue starts in one of these places.

  1. The wrong Medicare codes for how the drug arrived

    Medicare's bundled Spravato session codes may be billed only when the supervising professional also supplies the drug. If a pharmacy delivers the patient's own product instead, CMS says the visit and the observation are billed with ordinary office visit and prolonged-service codes. A clinic that uses both supply routes needs both set-ups.

  2. A second visit billed on session day

    CMS has said that billing a separate office visit with the Spravato session codes would be duplicative. The session codes already include the visit and the observation. Visits on other days for the patient's depression can still be billed.

  3. Claims still built on a deleted drug code

    On January 1, 2026, CMS replaced the temporary per-milligram code for esketamine with a permanent drug code, and the old one was deleted. A fee schedule or claim template still built on the old code needs updating. Medicare does not cover the new drug code on its physician fee schedule; it pays through the session codes.

  4. The drug billed on top of a Medicare session

    For Medicare, the esketamine is a supply inside the bundled session code. CMS says it cannot be billed separately with those codes. Adding it as its own line is an error.

  5. A missing monitoring form

    The REMS requires a Patient Monitoring Form within 7 calendar days after every session. It records the dose, the lot number, the total monitoring time and whether vital signs and pulse oximetry were acceptable. A late or missing form leaves that session out of step with the REMS.

What Medtransic runs and what your clinic keeps

What we run

What stays with you

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.

It works in any browser, on your desk or your phone. iPhone and Android apps are coming soon. See the client portal.

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, updating the REMS website workflows. These rules come from the label and the REMS forms on FDA's site, as checked on October 4, 2026.

Clinic certification. An outpatient clinic must be certified, because certified pharmacies may dispense Spravato only to certified settings. It needs a prescriber on site during dosing and monitoring, staff to monitor patients and a pulse oximeter. Enrollment asks for the DEA registration tied to the clinic's address.

Patient enrollment and a check before every dose. Each outpatient is enrolled before treatment starts, and the clinic confirms enrollment before every dose. After each session, the clinic files the Patient Monitoring Form within 7 calendar days. The current form is for outpatient offices only, not emergency departments.

What the monitoring form records. The form asks for the dose, the lot number and the total time from the first device to the end of monitoring, with a reason if that was under 2 hours. It asks yes or no whether vital signs and pulse oximetry were acceptable at set points in the session. It also asks about sedating medicines, the monitoring provider and any serious adverse event.

At least 2 hours of observation. A session is the patient using the nasal spray under a provider's direct supervision, then being watched for at least 2 hours, including pulse oximetry. Blood pressure is checked before the dose and again at about 40 minutes. The patient leaves only when it is safe.

Records, audits and no take-home doses. The clinic keeps a record of every shipment and every dose: patient, dose, number of devices and date. It must allow audits by the manufacturer or a third party. It may not dispense the drug for use outside a certified setting, or transfer, lend or sell it.

Two ways to get the drug. A REMS-certified pharmacy can deliver a patient's own drug to your clinic on a patient-specific prescription, or you can buy bulk supply from a REMS-qualified distributor. For Medicare, the route decides the codes, because the bundled session codes need the clinic to supply the drug. For commercial plans we confirm with each payer how it wants the session and drug billed.

Dose and schedule. Each device delivers 28 mg, so a 56 mg dose uses 2 devices and an 84 mg dose uses 3, with a 5-minute rest between devices. 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. Benefit is checked at the end of the 4-week induction phase.

Getting a Spravato clinic ready to bill

A claim can only be paid once the clinic, the prescriber, the patient and the plan are each in place. This is the order we work through with a new clinic.

  1. Your clinic is certified in the REMS

    Certification comes first, because certified pharmacies may only send Spravato to certified clinics. Your clinic completes the enrollment with the REMS.

  2. Your prescribers are credentialed with each payer

    We credential your psychiatrists and other prescribers with Medicare and the commercial plans you want to take. Our psychiatry page covers the rest of psychiatric visit billing.

  3. Benefits are checked and approval is on file

    Before the first session we check the patient's plan and request prior authorization where the plan requires it. Each commercial plan sets its own rules, so we read that plan's current policy rather than assume.

  4. The patient is enrolled in the REMS

    Your clinic enrolls the patient before the first dose and confirms enrollment again before every dose.

  5. A claim goes out after each session

    For Medicare we bill the session code that matches the dose given, or the visit and prolonged-service codes when a pharmacy supplied the drug. For a commercial plan we bill the way that plan requires.

Credentialing is $150 per application, per provider. In our experience it usually takes 60 to 90 days with each payer. Your client portal shows each application and its stage, the documents we need from you, and your claims; it is included with every client account.

How payers treat Spravato and ketamine

Medicare, when your clinic supplies the drug

Medicare pays each session with one of two bundled codes: up to 56 mg, and more than 56 mg. Each covers the visit, the supervised self-administration, 2 hours of observation and the drug, for established patients. Both are active, separately paid codes on the 2026 physician fee schedule.

Medicare, when a pharmacy supplies the drug

The bundled session codes cannot be used. CMS says the visit and the extended observation are billed with ordinary office visit codes and prolonged-service codes instead.

The 2026 drug code

Since January 1, 2026, esketamine has a permanent per-milligram drug code that replaced the temporary one. Medicare lists the new code 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 for each patient's plan before the first session, and request approval where it is required.

Ketamine

FDA states that ketamine is not approved for any psychiatric disorder. Its approved use is as an anesthetic given by IV or intramuscular injection; Spravato is the approved esketamine product for depression. We check each patient's plan before treatment, so you know whether to plan for self-pay.

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. We bill the sessions and handle the payer side, but 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 that covers the visit, the drug and 2 hours of observation. There are two levels, by dose: 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; its approved use is as an anesthetic. 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 revenue audit before you sign is free.

Sources

Outside facts on this page were checked against these sources on the date shown.

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