Billing and Coding: Esketamine

Medicare billing/coding for SPRAVATO (esketamine) is limited to administration at FDA REMS‑enrolled sites for the FDA‑approved indication—treatment‑resistant depression (TRD) in adults—and other uses are not supported by CMS‑approved compendia and should not be billed as covered. Key requirements: select diagnosis codes per the FDA label, administer and monitor under REMS for sedation/dissociation/respiratory depression, use the appropriate modifier for non‑covered services, and ensure compendia support to avoid Medicare sanctions.