If your Spravato claims started bouncing back in January, there is a good chance the code you had been using no longer exists. S0013 was terminated on December 31, 2025 and replaced by J0013 from January 1, 2026. That one change is behind a lot of the denials interventional psychiatry clinics have been untangling this year.
The confusing part is that fixing it is not as simple as swapping one code for another. Which codes you bill depends on how the drug reaches your office, and payers do not agree with each other about what to do next.
Here is the current code set, what decides which half of it applies to you, and where the claims actually fail.
The code that changed
J0013 took effect on January 1, 2026. Its official descriptor is “Esketamine, nasal spray, 1 mg”, and it replaced S0013, a temporary code that was terminated at the end of 2025.
Two things about it catch people out.
The unit is a milligram, not a device. A 56 mg dose is two devices but 56 units. An 84 mg dose is three devices but 84 units. Billing 2 or 3 because that is how many devices you used is a fast way to a denial or a badly underpaid claim.
Medicare will not pay it separately. J0013 carries a Medicare coverage indicator of “I”, meaning not payable by Medicare. It is a national HCPCS code rather than a commercial-only one, and Janssen’s guidance describes it as being for use with Medicaid agencies and other payers as they deem appropriate. But if you are billing Medicare for the drug, J0013 is not the route.
Janssen also notes that some payers may continue to use J3490, the unclassified drug code, during the transition. If a payer told you to do that in January, it is worth asking again now rather than assuming the workaround is permanent.
The full code set
| Code | What it covers | Who it applies to |
|---|---|---|
| J0013 | Esketamine, nasal spray, 1 mg. Billed in milligrams: 56 or 84. | Non-Medicare payers. Not separately payable by Medicare. |
| J3490 | Unclassified drugs. A transitional fallback where a payer has not adopted J0013. | Non-Medicare, by payer instruction only. |
| G2082 | Established patient office visit with supervision and up to 56 mg of esketamine self-administration, including 2 hours of post-administration observation. | Medicare, and other payers that accept bundled billing. |
| G2083 | The same, for greater than 56 mg. | Medicare, and other payers that accept bundled billing. |
| G0463 | Hospital outpatient clinic visit. | Medicare, hospital outpatient departments sourcing the drug from a REMS-certified pharmacy. |
| 99202–99205 99212–99215 | Office or outpatient E/M, new and established patient. | Both, when billing unbundled. |
| 99415 / 99416 | Prolonged clinical staff service with physician supervision. First hour, then each additional 30 minutes. | Both. |
| 99417 | Prolonged E/M, each 15 minutes. | Non-Medicare only. |
| G2212 | Medicare’s prolonged service code, used in place of 99417. | Medicare only. |
Note what is inside the G2082 and G2083 descriptors: the visit, the drug, and the two hours of observation, all in one code. Both took effect on January 1, 2020 and neither was touched by the 2026 change. That bundling is the source of most of the confusion below.
How you get the drug decides which codes you use
This is the fork, and everything else follows from it.
If you buy and bill, meaning the product comes to your office through a specialty distributor and you own it until it is administered, the bundled G codes are built for you. Janssen’s coding guidance is unambiguous: bundled G codes may only be billed when the product is acquired by an office through a specialty distributor, and may not be used if product is acquired from a specialty pharmacy.
If a specialty pharmacy supplies the drug, shipped to you patient by patient, the pharmacy bills the drug. You bill the visit and the observation time. J0013 belongs to whoever is actually supplying the product, and in this model that is not you.
Getting this backwards produces a specific and avoidable denial: billing G2082 for a dose the pharmacy already billed, or billing J0013 for a drug you bought under a bundled arrangement. Neither is a coding error exactly. It is a mismatch between the code and the supply chain.
Where payers disagree
The acquisition rule above comes from the manufacturer and is consistent nationally. What is not consistent is whether a given payer will accept bundled billing at all.
Highmark’s reimbursement policy for esketamine, effective January 1, 2026, tells professional providers running buy-and-bill that they should not unbundle their services and bill using J0013 or J3490, and should use G2082 or G2083 instead. That policy applies to its Commercial and Medicare Advantage plans in Pennsylvania, West Virginia, Delaware and New York, so do not assume it describes your payer just because it is written down somewhere.
Wellpoint takes the opposite position in its esketamine coding standard operating procedure, which states that if the provider bills packaged codes G2082 or G2083, these codes will not be reimbursed. Providers are directed to the unbundled E/M and drug codes, with the drug requiring pre-approval through CarelonRx. Two caveats on that document: its stated scope is facility providers, where Highmark’s policy governs professional providers, so the two may not be as directly opposed as they first appear. And it is undated and still names S0013 as the drug code, which tells you it predates the J0013 transition. Do not follow it literally on the drug code.
That last point is the real lesson. Payer policy documents go stale, and a January code change makes a lot of published guidance wrong at once, including guidance sitting on payer websites. There is no correct national answer to “how do I bill Spravato”, and anyone who gives you one without asking which payer you mean is guessing.
The workable approach is boring. Pull your top five payers by Spravato volume and confirm in writing, per payer, whether they want bundled or unbundled, which drug code they are currently loading, and whether prior authorization is required and still valid. That list is worth more than any billing guide, including this one.
Where the claims actually fail
A terminated code. S0013 is gone. If it is still sitting in a template, a superbill, or an EHR favorites list, it will keep going out.
Units billed as devices. J0013 is per milligram. Fifty-six, not two.
Bundled and unbundled on the same claim. The observation time is already inside G2082 and G2083. Adding 99415 on top will read as duplicate billing for the same two hours.
Documentation that does not support two hours. The G code descriptors say two hours of post-administration observation. If the note does not show the patient was observed and assessed for that long, the claim does not survive review, whatever the code says.
99417 sent to Medicare. Medicare wants G2212. This one is easy to fix and easy to keep getting wrong, because non-Medicare claims take 99417 without complaint.
Prior authorization that expired mid-course. Spravato runs twice weekly for four weeks, then weekly, then every one to two weeks. An authorization written for the induction phase can quietly run out partway through maintenance, and the denials arrive weeks after the sessions did.
What to check this week
If you do nothing else, do these four.
Search your EHR and billing templates for S0013 and remove it. Confirm with your top five payers whether they want bundled or unbundled for the current plan year, and which drug code they have loaded. Check that your units are milligrams. And pull three recent Spravato notes to see whether they would survive a request for records on the two-hour observation.
Common questions
What is the CPT code for Spravato?
Strictly there is not one. The codes used for the drug and the bundled visit are HCPCS Level II codes rather than CPT codes: J0013 for the drug, G2082 and G2083 for the bundled visit. The CPT codes that appear on a Spravato claim are the E/M and prolonged service codes, 99202–99215, 99415, 99416 and 99417. People search for Spravato CPT code because that is what everyone calls them, but knowing the distinction helps when you are on the phone with a payer.
Is there a J-code for Spravato?
Yes, as of January 1, 2026. J0013, esketamine nasal spray, 1 mg. Before that there was no permanent J-code, and claims used S0013, a temporary code, or J3490.
Do G2082 and G2083 still exist?
They do. Both took effect on January 1, 2020 and remain active and unchanged. The 2026 change affected only the drug code.
Can I bill an E/M on the same day as the treatment?
It depends which model you are in. Under the bundled G codes the visit is already included, so a separate E/M for the same encounter is duplicate billing. Under an unbundled arrangement the E/M is how you bill the visit. A genuinely separate and significant service on the same day is a different question and turns on documentation and modifier use, which is worth asking your biller about rather than a website.
What about Medicare?
Medicare uses the bundled G codes and does not separately pay J0013. Hospital outpatient departments sourcing the drug from a REMS-certified pharmacy bill G0463 instead. For prolonged service, Medicare wants G2212 rather than 99417.
Does Medicaid follow the same rules?
Not reliably. Medicaid coverage for esketamine is set state by state, and the code, the prior authorization requirements and the acquisition rules can all differ from both Medicare and your commercial contracts. If Medicaid is a meaningful share of your Spravato volume, treat it as its own payer with its own written answer.
The part billing does not solve
Clean coding decides what you keep from a chair that is occupied. It does nothing about the chairs that are not.
That is a separate problem with separate causes, and in our experience it is the more expensive one. A Spravato program running at sixty percent capacity with immaculate billing is losing more revenue to the empty forty percent than it will ever recover by fixing denials. Both are worth doing. Only one of them has a ceiling, and we wrote about where that ceiling comes from in what the Spravato REMS actually requires.
A note on what this is: we are a marketing agency for mental health clinics, not a billing company. We put this together because our Spravato clients kept asking, and because most of what is published on the subject is thin or out of date. Codes, payer policies and prior authorization rules change, sometimes mid-year. Verify anything here against your own contracts and your biller before you act on it.
If the problem you actually have is an underfilled Spravato schedule rather than a coding one, that is what we do. See marketing for Spravato clinics, or read how we think about where interventional psychiatry patients come from. The audit is free and we will tell you if the answer is that you do not need us.
Sources
Code descriptors, effective dates and Medicare coverage indicators from the HCPCS Level II code set (J0013, G2082, G2083). Acquisition rules, unit counts and payer applicability from Janssen’s SPRAVATO coding overview. Payer positions from Highmark reimbursement policy RP-083 and Wellpoint’s esketamine coding and billing guidelines. Dosing schedule from the FDA prescribing information. Last reviewed August 2026.
