KMAP BULLETIN: Billing Guidance for Spravato®

Date: 10/06/22

KMAP GENERAL BULLETIN 22252 (PDF)

Effective with dates of service on and after November 1, 2022, the following additional billing guidance goes into effect when the drug Esketamine Intranasal (Spravato®) is billed. HCPCS code 99215 with modifier U1 will now be covered for the first 54 minutes. For additional observation time, HCPCS code G2212 and modifier U1 will be used for additional time in 15-minute increments. Modifier U1 is required with both 99215 and G2212 to designate the service is associated with Spravato® administration observation. Code 99215 without modifier U1 will no longer be covered for the initial observation period.

A provider may delegate the remaining observation time (G2212 U1) to a registered nurse under the provider’s supervision. However, written policy and procedure guidance for delegation of billing code G2212 U1 needs to be in place for patient safety and audit purposes.

Note: The effective date of the policy is November 1, 2022. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.