Spravato Treatment Billing and Reimbursement Changes

Beginning January 1, 2027, Horizon will standardize billing and reimbursement for Spravato® treatment across all lines of business.

A transition period will be in place from September 1, 2026 to December 31, 2026 to allow providers time to move to the new billing requirements.

During the transition period (September 1, 2026 and December 31, 2026)

• Providers should begin submitting claims using the below methodology as soon as possible.
• Existing authorizations may continue to be billed using the approved authorization codes through December 31, 2026.
• Providers that have approved authorizations for "J" codes (other than specialty pharmacies), that extend beyond December 31, 2026 do not need to complete new authorization requests. The J code authorization will be transitioned to a G code authorization beginning January 1, 2027.
• Specialty pharmacies will continue to bill with J codes.
• New authorization requests should be submitted using the new billing methodology.

Billing requirements beginning January 1, 2027

Commercial, Medicare and DSNP

Providers who purchase Spravato® themselves will only be reimbursed through the bundled billing codes:

• G2082
• G2083

Medicaid

Providers who purchase Spravato® themselves should use the following billing codes:

• G2082 or G2083
• 99202-99205 or 99212-99215
• G2212 for extended observation
• J0013 for medication

Providers who do not purchase Spravato® themselves

Use the following billing codes:

• 99202-99205 or 99212-99215, plus
• G2212 for observation

Important billing reminder

Codes G2082 and G2083 include the medication, administration and observation services. Claims will be denied or subject to overpayment recovery if both:

• A bundled G-code claim is submitted, and
• A medication claim is billed separately

Overpayments occur when both a G code and a J code claim are submitted within three days of each other.

Prior authorization

Prior authorization applies to the Spravato® medication only.

Once the medication is authorized, a separate authorization is not needed for related administration and observation services.

Because Spravato® is a medical benefit, authorization requests should be submitted as follows:

Commercial: Prime Therapeutics - Medical Injectable Program

• Call: 1-800-424-4508, Fax: 1-888-656-6805

Medicaid: Horizon Behavioral Health Team - claims submitted via Availity Essentials

Medicare: Prime Therapeutics - Medical Injectable Program

• Call: 1-800-424-4508, Fax: 1-888-656-6805

DSNP: Horizon Pharmacy - Medical Injectable Program

• Call: 1-800-664-2583

Questions?

If you have questions about these billing and reimbursement requirements, please contact the Network Specialist for your geographic area (Behavioral Health Network Specialist Assignments - Horizon Blue Cross Blue Shield of New Jersey).