intranasal ketamine charge

[greyrock]

Hi, I had a question for anyone who uses ketamine treatment for patients... How do you guys charge for this service? (insurance or no insurance)
It is quiet time extensive - as you are required to monitor patients for 120minutes.
Would appreciate any feedback! thanks.

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[romanticscience]

On this topic, how do you store the stuff? I was considering offering it until I got overwhelmed by this.

 

[greyrock]

On this topic, how do you store the stuff? I was considering offering it until I got overwhelmed by this.

I believe it has to be stored in double-locked cabinet as it is a controlled substance...
It's very exciting to have Spravato released on the market, however how are you supposed to utilize it for patient care on a practical basis?
this comes with needing space to monitor the patients for 2 hours, and billing/codes that need to adequately compensate for this...
anyone familiar with using intranasal ketamine??

 

[nexus73]

I thought I read a facebook post where a psychiatrist's father, who was a retired doctor from some other specialty, would "monitor" the patients for the duration of their 120 minutes and they would bill out 99215 plus whatever extended service codes based on the total time "face to face" with the patient. It sounded like they were getting paid by insurance which was surprising. And her retired father was having a grand old time chit chatting with patients who had been given their ketamine.

 

[greyrock]

I thought I read a facebook post where a psychiatrist's father, who was a retired doctor from some other specialty, would "monitor" the patients for the duration of their 120 minutes and they would bill out 99215 plus whatever extended service codes based on the total time "face to face" with the patient. It sounded like they were getting paid by insurance which was surprising. And her retired father was having a grand old time chit chatting with patients who had been given their ketamine.

that sounds like a pretty good retirement job! do you know if the doc was billing for psychotherapy codes?

 

[nexus73]

that sounds like a pretty good retirement job! do you know if the doc was billing for psychotherapy codes?

I think it was on the facebook ketamine psychiatry group. I think the dad was like a retired pulmonologist or something, so wouldn't be able to bill psychotherapy.

 

[Sushirolls]

There are details for billing on the spravato website, PDF buried some where on how to do things and which codes.

 

[Ironspy]

I bill for time and monitor patients over video from my office down the hall. I can monitor 2 patients at a time this way and typically stagger patients 1h

 

[greyrock]

I bill for time and monitor patients over video from my office down the hall. I can monitor 2 patients at a time this way and typically stagger patients 1h

can I ask which codes you bill for? 99213/99214/99215 + psychotherapy code (90386/903830)?

 

[Sushirolls]

Your answers are right here, where I previously mentioned you'd find them:

https://www.spravatohcp.com/sites/www.spravatohcp.com/files/spravato_access_reimbursement_guideline.pdf?v=230711

 

[calvnandhobbs68]

can I ask which codes you bill for? 99213/99214/99215 + psychotherapy code (90386/903830)?

Dude stop with the psychotherapy code. Ain't no insurance gonna pay you for a psychotherapy add on for Spravato monitoring and I'd be really concerned if they did pay that they'd claw that money back ASAP with any kind of audit. Just bill the E+M code and move on.

Spravato just doesn't tend to make a ton of money overall for offices unless you're doing it all day every day (kind of like TMS clinics). Basically most clinics offer it so they can offer patients another med option but from what I've heard from people it's not a big money maker.

 

[TexasPhysician]

In every way that I’ve looked at it, there is no money using Spravato. The space could be used a dozen ways more lucratively. In talking to academic centers, their Spravato clinic is losing money. Staff spend hours to get approval and deal with insurance.

Cash based with racemic ketamine is different. You charge what you want. You still have logistical issues and monitoring though.

 

[Asklepian]

Typically billing 99214 + 99415

 

[NickNaylor]

We bill by time (usually 99214) along with prolonged service code for staff observation (99415), as noted above.

Not too familiar about the specific storage requirements, but I do know that our clinic staff very closely documents and stores it securely since it's a controlled substance.

Agree with @TexasPhysician in that there is no money with Spravato, especially as an outpatient doc with low volume. We have a pretty busy Spravato program and it's a huge money drain: requires lots of staff resources, requires space for monitoring, and you really can't bill all that much for it.

 

[robellis]

We bill by time (usually 99214) along with prolonged service code for staff observation (99415), as noted above.

Not too familiar about the specific storage requirements, but I do know that our clinic staff very closely documents and stores it securely since it's a controlled substance.

Agree with @TexasPhysician in that there is no money with Spravato, especially as an outpatient doc with low volume. We have a pretty busy Spravato program and it's a huge money drain: requires lots of staff resources, requires space for monitoring, and you really can't bill all that much for it.

So why would anyone offer it? Doesn’t seem to make much sense given the reliance on NPs and PAs due to cost cutting..only the big academic programs will probably offer it then such a disservice to patients

 

[NickNaylor]

So why would anyone offer it? Doesn’t seem to make much sense given the reliance on NPs and PAs due to cost cutting..only the big academic programs will probably offer it then such a disservice to patients

We (an academic center) offer it because our institution believes that we need to be able to offer essentially any and all treatments that are clinically appropriate, to the point that they are willing to take a financial loss to do so.

 

[clozareal]

In the pdf that @Sushirolls posted, the coding is 99215 + 99417 x3 (or more for each additional 15 minutes) for non-medicare established patient and if you are the one providing direct supervision and not your staff. The wRVU for 99417 seems to be 0.61.

 

[Sushirolls]

In the pdf that @Sushirolls posted, the coding is 99215 + 99417 x3 (or more for each additional 15 minutes) for non-medicare established patient and if you are the one providing direct supervision and not your staff. The wRVU for 99417 seems to be 0.61.

The next issue is which insurance companies will pay for the 99417? One company that is a big chunk of my panel, which I'm in the process of dropping, doesn't cover it. Another company also a big chunk of my panel doesn't cover it. One tiny insurance company wants chart notes submitted with this code.

I've thought about having/using a conference room to be 'spravato time' and all the patients come at that time block only. But similar to group therapy, will only work if you continue to have X % occupancy of the group - or you run a loss for that time block.