Billing and Coding: Esketamine

Medicare billing/coding guidance allows SPRAVATO (esketamine) coding only for the FDA‑approved indication—treatment‑resistant depression (TRD) in adults—and when administered at sites enrolled in the FDA REMS program; other uses not supported by CMS‑accepted compendia are not supported for Medicare coverage. Key requirements: use TRD diagnosis codes per the FDA label, comply with REMS monitoring for sedation/dissociation/respiratory depression, do not bill non‑covered services as covered (use the appropriate modifier), and note that prescribing unsupported uses may lead to Medicare sanctions.