In the September issue of Insights and Updates for Providers, Point32Health announced that effective Nov. 1, 2023, providers billing for Spravato (esketamine) nasal spray for Harvard Pilgrim commercial members would be required to include the HCPCS codes G2082 or G2083 on the medical claim.
We would like to offer a reminder of this billing requirement, as well as clarification that HCPCS S0013 should not be billed alongside G2082 or G2083 if providing drug and administration/observation. When requesting the use of Spravato nasal spray, please use one of the following billing codes to request prior authorization for the provision of the drug and professional services associated with Spravato therapy:
- G2082 – office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation.
- G2083 – office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self-administration, includes 2 hours post-administration observation.
For these requests, the prescribing provider must request coverage through the medical review process subject to the applicable pharmacy medical necessity guidelines.
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