Understanding Spravato: The Medication Behind New York’s Innovative Depression Therapy

Depression continues to be one of the most common and challenging mental health disorders in the United States. For patients who have not responded to conventional antidepressants, new treatment options are providing real hope. One of the most transformative advancements in recent years is Spravato® (esketamine)—a prescription nasal spray approved by the U.S. Food and Drug Administration (FDA) for treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal ideation or behavior.

In New York, more behavioral health and psychiatry providers are adopting Spravato therapy as part of a comprehensive mental health care approach. However, understanding what the medication is, how it works, and how to bill it compliantly is essential for both providers and billing professionals.

💊 What Medication Is Used in Spravato Treatment?

Spravato contains esketamine hydrochloride, a derivative of ketamine that targets N-methyl-D-aspartate (NMDA) receptors in the brain. Unlike traditional antidepressants that focus primarily on serotonin, norepinephrine, or dopamine pathways, esketamine acts on the glutamatergic system, which helps rebuild and strengthen synaptic connections disrupted by depression.

The medication is not self-administered. It must be given in a certified healthcare setting under the Spravato REMS (Risk Evaluation and Mitigation Strategy) Program, as required by the FDA. Each treatment session includes:

• Patient assessment before dosing
• Direct supervision during administration
• Observation period of at least two hours after dosing
• Documentation of patient response and any adverse effects

This strict clinical structure ensures patient safety and compliance with federal regulations.

🏙️ How Spravato Therapy Is Delivered Across New York

In New York, licensed behavioral health clinics, psychiatry practices, and integrated care centers offer Spravato therapy for eligible patients. Providers must maintain REMS certification and ensure their facilities meet all federal and state requirements for safe medication handling and patient monitoring.

Spravato is typically prescribed alongside an oral antidepressant, forming a combination treatment plan that enhances clinical outcomes. Each dose and session is carefully documented in the patient’s medical record, ensuring that care delivery aligns with payer and FDA expectations.

⚖️ Compliance Considerations for Spravato Billing

Because Spravato involves both a medication and an administration service, correct documentation and coding are crucial. Failure to follow billing guidelines may result in claim denials, audits, or recoupments. To maintain compliance, providers should ensure the following:

1. Verify Payer Authorization:
   Many commercial and government payers require prior authorization before starting Spravato therapy. Documentation should clearly state the patient’s diagnosis, treatment history, and clinical justification for esketamine use.
2. Use Correct Coding and Modifiers:
   1. HCPCS Code: J3490 (unclassified drugs) or specific payer-designated code for Spravato (when available).
   1. CPT Code: 96372 (therapeutic administration) or appropriate drug administration code depending on payer guidance.
   1. Include diagnosis codes such as F32.9 (Major depressive disorder, single episode, unspecified) or F33.2 (Recurrent major depressive disorder, severe, without psychotic features) when clinically appropriate and supported by documentation.
3. Follow REMS Documentation Rules:
   All administration and observation notes should be completed during the session. The facility must maintain REMS enrollment and monitoring logs for every patient receiving Spravato.
4. Ensure Time-Based Documentation:
   Because observation and recovery are part of the supervised session, accurately documenting start and end times is essential for compliance and audit protection.
5. Maintain Privacy and HIPAA Standards:
   Patient records, authorizations, and session notes must be stored securely and shared only with authorized entities, in line with HIPAA and 42 CFR Part 2 regulations.

💼 How Solubillix Supports Spravato Billing and RCM

At Solubillix, we recognize that Spravato therapy represents both an innovative clinical opportunity and a complex reimbursement challenge. Our behavioral health billing experts specialize in managing the unique compliance, coding, and reimbursement structure associated with esketamine treatments.

We assist New York-based providers by delivering:

• Accurate claim coding aligned with payer-specific requirements
• Authorization tracking and verification for every treatment session
• Denial management and appeal support for rejected or underpaid claims
• Comprehensive compliance review to minimize audit risk
• Detailed revenue reporting for Spravato and other behavioral health services

With our guidance, providers can stay compliant, reduce administrative burden, and ensure that every Spravato session is reimbursed correctly and promptly.

🌟 The Future of Depression Care

Spravato marks a new chapter in how depression is treated—especially for patients who have struggled with years of ineffective medications. For healthcare organizations across New York, adopting Spravato therapy means offering patients renewed hope while navigating a complex billing landscape.

Solubillix stands beside providers every step of the way—ensuring accurate claims, compliant documentation, and efficient revenue cycle management—so clinicians can focus on what truly matters: helping patients heal.