Spravato CPT Codes

[pike73]

I am in private practice and considering performing some Spravato treatments. I am trying to get an idea of the reimbursement for these treatments. Can anyone let me know the CPT Codes that are being approved by major insurers? I know the treatments are more involved in terms of monitoring and time and may not be financially worthwhile. Also, given Ketamine-Assisted Therapy is becoming more well-known, is anyone incorporating Add-On Codes to Spravato treatment and doing this therapy? Any input would be greatly appreciated.

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[Merovinge]

If you are in solo PP I cannot imagine Spravato would be worth it financially, you need a nice/cozy place and you are unlikely to utilize it very frequently. I certainly wouldn't want to be a patient getting Spravato in a converted closet 🤣. The prior authorization is very tedious and you need very through documentation to obtain it. We have a staff dedicated to this and are no where near full-time on them despite having 9 MDs in the organization. You need a lot of volume to make this worth considering, particularly because many patients are electing for IV ketamine these days with better efficacy data.

 

[clausewitz2]

If you are in solo PP I cannot imagine Spravato would be worth it financially, you need a nice/cozy place and you are unlikely to utilize it very frequently. I certainly wouldn't want to be a patient getting Spravato in a converted closet 🤣. The prior authorization is very tedious and you need very through documentation to obtain it. We have a staff dedicated to this and are no where near full-time on them despite having 9 MDs in the organization. You need a lot of volume to make this worth considering, particularly because many patients are electing for IV ketamine these days with better efficacy data.

And on the lower end of costs/inconvenience the compounding pharmacies making ketamine nasal sprays and deliver them to patient's house eat your lunch from the other direction.

 

[Celexa]

And on the lower end of costs/inconvenience the compounding pharmacies making ketamine nasal sprays and deliver them to patient's house eat your lunch from the other direction.

This does mean that if you think a patient would benefit from ketamine, you can in fact prescribe it without all the hoops of spravato.

But in terms of making spravato a revenue generating part of a practice, I agree, although I haven't been directly involved with the conversations I have heard second hand from people involved in efforts to do it at multiple institutions and the economics don't seem to be there.

 

[TexasPhysician]

I am in private practice and considering performing some Spravato treatments. I am trying to get an idea of the reimbursement for these treatments. Can anyone let me know the CPT Codes that are being approved by major insurers? I know the treatments are more involved in terms of monitoring and time and may not be financially worthwhile. Also, given Ketamine-Assisted Therapy is becoming more well-known, is anyone incorporating Add-On Codes to Spravato treatment and doing this therapy? Any input would be greatly appreciated.

If you enjoy therapy, you could do general 99214 + therapy add-on. Spravato isn’t a big money generator. It may add some revenue to insurance based practices or counseling patients if you enjoy counseling. Hard pass for out-of-network practices.