Spravato Billing Services
Your Spravato program has two compliance obligations. We manage both — REMS and RCM, as one integrated workstream.
Trusted by 270+ healthcare organizations nationwide
Why Multi-Site Revenue Cycle Breaks Down
When you scale locations, billing complexity scales faster. Most practices that grow from 3 to 10 to 20 locations don’t scale their RCM infrastructure with them. What worked at one site creates compounding problems at five.
J-Code Billing Complexity
Esketamine must be billed as a drug claim (J3490/J3590) with exact NDC, dosage, and units. Errors trigger immediate denials and OIG audit flags.
REMS-to-Billing Linkage
REMS documentation must correlate to billed administration sessions. Mismatches between REMS records and claim dates are a top-3 denial trigger.
E&M + Therapy Unbundling
Concurrent therapy billing alongside Spravato requires precise modifier application. Unbundling errors (90838 vs 90837+90833) create clawback exposure.
Prior Auth Expiration Risk
Many payers require PA renewal every 4–8 sessions. Billing without active auth — even one session — results in full claim denial with minimal appeal pathway.
Undercoding Administration
Spravato administration codes carry significant revenue. Providers often code conservatively, leaving documented complexity unbilled. CDI closes this gap.
Payer-Specific Coverage Rules
Coverage criteria vary by payer for treatment-resistant depression vs. MDD with suicidality. Misapplied medical necessity language is the #1 PA denial reason.
Four Service Areas. One Integrated Program.
Built for Spravato from the ground up — not adapted from a general behavioral health billing workflow.
Benefits Verification
Know the Coverage
Before the Drug Is Purchased
Eliminate buy-and-bill surprises before they happen
- Medical vs. pharmacy benefit path confirmed before the first session
- Eligibility & network status — real-time verification per patient
- Copay, deductible & out-of-pocket written pre-treatment estimate
- REMS enrollment cross-check aligned to payer coverage on file
- TRD vs. MDD-SIBA coverage mapping — payer-specific medical necessity
Prior Authorization
Zero Delays.
First-Pass Approvals.
PA initiated before the first session, not after
- Payer-specific auth workflows mapped per patient, service, session count
- Clinical documentation packaging — diagnosis, failed trials, REMS-aligned
- Daily follow-up & SLA escalation — no silence on pending auths
- PA expiration tracking — renewals initiated before auth lapses
- Formal appeals & peer-to-peer support with medical necessity documentation
Spravato & Specialty Billing
Built for Accuracy.
Every Claim Tracked.
NDC from the specific lot on every claim
- Drug claim billing (J3490/J3590) — NDC from the specific lot on every claim
- Therapy & E&M billing — 90837, 90833, 99213–99215 + correct modifiers
- Pre-claim REMS cross-check — documentation verified before submission
- Denial management & A/R recovery — every denial worked, root cause logged
- Live Power BI dashboard — clean-claim rate, denial rate, A/R aging
Medical Coding Audit
Compliance &
Revenue Protection.
CPC-certified review on every encounter
- CPC-certified coding review — ICD-10, CPT, HCPCS compliance
- E&M level validation — MDM and time-based criteria per encounter
- Spravato-specific CDI support — documentation gaps tied to coding accuracy
- OIG-ready corrective action plans — defensible under audit or inquiry
- Trend reporting & coder training — quarterly analysis and upskilling
Six Stages. Every Gap Eliminated.
Every Neolytix Spravato program follows a six-stage workflow designed to eliminate the gaps between REMS compliance and revenue cycle operations.
Program Onboarding & REMS Setup
We confirm REMS certification status, map every active patient to the compliance calendar, and establish your drug inventory log. All REMS portal credentials verified before the first session is billed.
Benefits Verification & Benefit Path Confirmation
Before the first session, we determine whether coverage routes through medical or pharmacy benefit — the most common missed step that leads to denials.
Prior Authorization Initiation
PA is initiated before the first session, not after. Clinical documentation is packaged to payer-specific requirements. Daily follow-up begins immediately.
REMS Session Compliance
After every treatment session, the Patient Monitoring Form is filed within the 7-day window. Compliance records cross-referenced to billing calendar — gaps identified pre-claim.
Claim Submission & Scrubbing
Claims are built with the correct G2082/G2083 code, J0013 drug code, and NDC from the specific lot purchased. Every claim passes ML scrubbing before submission.
Denial Management & A/R
Denials are worked within 48 hours. A/R aging monitored weekly, underpayments flagged for renegotiation. Monthly KPI dashboard delivered to your team.
Contracted, Not Estimated.
These benchmarks are included as performance SLAs in every Neolytix service contract — not marketing claims.
<5%
Behavioral health avg: 8–12%
95%+
Industry avg: ~80%
<48h
From encounter date
<10%
Behavioral health avg: 8–12%
98%+
Spravato-coded claims
15 days
From contract execution
Purpose-Built Specialist vs. Generic Vendor
Not all Spravato billing companies are the same. Here is what separates a purpose-built specialist from a generic vendor.
| Capability | Neolytix | Generic Billing Vendor |
|---|---|---|
| Spravato J-code billing with NDC-specific workflow | Purpose-built, NDC from specific lot on every claim | No NDC-specific workflow documented |
| REMS documentation cross-check before submission | Every session, flagged pre-claim | Not in scope |
| PA expiration tracking — renewal before auth lapses | Proactive, tracked by session count | Reactive or manual |
| Live dashboard — claim visibility, denial rate, A/R | Power BI, real-time | Monthly report |
| AR DaysNamed account contact Target | Direct line, not a support queue | Ticket-based support |
| Fee structure | % of Spravato collections only, no minimums | Flat fee or blended practice rate |
| ISO 27001 + HIPAA certified | Independently audited | HIPAA only |
HIPAA-Compliant Operations
All patient data handled under strict HIPAA administrative, physical, and technical safeguards. BAA executed with every client.
ISO 27001 Certified
Independently audited information security management. Internationally recognized standard — your billing data protected at every layer.
REMS Audit-Ready Documentation
Every PMF, enrollment record, and drug inventory log maintained in audit-ready format, cross-referenced to billing records.
What Our Clients Say
Cheryl Lambert
Practice Administrator
Yasser Rivera
CEO
Case Studies
Real challenges. Measurable outcomes. Proven results across healthcare operations.
Prime Healthcare's Path to 98.5% First-Pass Enrollment
98.5%
First-Pass Approval
70%
Denial Reduction
40%
Faster Enrollment
50%
Revenue Increase
“Enrollment used to be a reactive, manual process that tied up significant resources. Neolytix gave us visibility and predictability. We can now flag problems early and prevent denials rather than chase them after they happen.”
— Operations Director, Prime Healthcare · 45+ hospitals · 300+ providers
Built for Compliance. Designed for Confidence.
Security-First. At Every Step.
Built for Compliance. Designed for Confidence.
Every service we deliver is built on a foundation of strict data governance and regulatory compliance. HIPAA safeguards and ISO 27001-certified security practices are embedded into how we work, not added after the fact.
FAQs
Frequently Asked Questions About Neolytix RCM
What are Spravato billing services?
Spravato billing services are specialized esketamine RCM services built for practices administering Spravato under the buy-and-bill model. A complete service covers four areas simultaneously: benefits verification (medical vs. pharmacy benefit path confirmation before the first session), prior authorization management, REMS compliance documentation, and buy-and-bill RCM including coding, claims submission, denial management, and A/R. Each area requires workflows purpose-built for esketamine — not adapted from standard outpatient psychiatry billing.
How does Spravato REMS compliance affect billing?
REMS compliance and billing are two parallel obligations that directly affect each other. Payers cross-reference REMS documentation — missing or late Patient Monitoring Forms can trigger denials. Non-compliance with REMS (including missing per-session filings within the 7-day window) risks losing drug ordering access entirely. This is why Spravato billing services should include dedicated REMS compliance management, not just claims submission. Neolytix manages both workstreams as a single integrated service.
What is buy-and-bill billing for Spravato?
Buy-and-bill means the practice purchases Spravato directly from a specialty distributor at $600 or more per dose before administering it, then bills the drug cost and administration services to the payer for reimbursement. The NDC number from the specific lot purchased must appear on every claim — a mismatch causes an automatic denial. This model puts significant drug cost at risk before any reimbursement is received, which is why buy-and-bill billing for Spravato requires a specialist with precise NDC workflow management.
How long does Spravato prior authorization take?
Typically 7 to 14 days for commercial payers when documentation is complete and payer-specific requirements are met. PA requires documented failure of at least two prior antidepressant trials, confirmed TRD or MDD-SIBA diagnosis, and REMS enrollment confirmation. Initial authorization periods range from 1 to 3 months. Re-authorization is required at the maintenance phase — a lapsed authorization results in denied claims on sessions already administered. Neolytix targets PA turnaround under 14 days for commercial payers with complete documentation and active management.
What billing codes are used for Spravato in 2026?
G2082 covers sessions with up to 56mg esketamine including the 2-hour post-dose observation. G2083 covers sessions above 56mg. J0013 is the drug HCPCS code effective January 2026, replacing S0013 for applicable payers. Some commercial payers remain on transition guidance — payer-specific verification is required at onboarding. The NDC from the specific lot purchased must accompany J0013 on every buy-and-bill claim. Using outdated codes or incorrect NDC pairing are the leading causes of Spravato claim denials in 2026.
What denial rate should a Spravato practice expect with a specialist billing company?
Without specialist management, industry benchmarks show more than 32% of Spravato claims are denied on first submission — a rate driven by REMS documentation gaps, NDC mismatches, and prior authorization errors that general RCM workflows are not built to catch. With Neolytix Spravato billing services, the target is a denial rate below 5% with a 98% or higher first-pass rate on Spravato-coded claims. These benchmarks are included as performance SLAs in the service contract.
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Your Spravato Program Deserves a Billing Partner Who Actually Knows It
Every session your billing is not Spravato-specific is revenue at risk — and drug cost already spent.
No commitment required. We’ll tell you whether our service is the right fit for your program.