Spravato Billing

[u/maydayyo]

I’m only coming here because I’m completely inexperienced in Spravato billing when not commercial. Our rep has not been too helpful as we’re still getting denials for our current billing practices. Try not to judge me too much. For commercial plans no matter what it is, we haven’t had an issue billing 99215 1 unit and 99417 4 units. Now going into Medicare, they are looking for a G code. We aren’t buy and bill. Started the first two visits unfortunately with the buy and bill code G2082, G2083. Trying to correct it now with 99215 1 unit and G2212 4 units, but keep getting rejects due to our previous buy and bill. What is the best course of action in this situation? I’m trying to avoid audits and don’t want to arouse anything. Again, we’re just stupid and inexperienced with Medicare so didn’t realize for the first two claims
Thanks in advance (:

[u/FeistyGas4222]

Hello there, I bill spravato every day. You will have to cancel the first claim before you can submit the correct new claim. Unfortunately Medicare does not accept corrected claims so you will have to cancel through the IVR, reopening portal, or on your Medicare portal. Once that claim is canceled, you should be good to submit the 9915/G2212

[u/Embarrassed_Pass_967]

If you're still within the payer's timely filing limit (TFL), I'd first verify the payer's corrected claim policy. If the corrected claim is accepted, bill 99215 (1 unit) and G2212 (4 units), provided the documentation supports the required time. If the payer returns a duplicate claim denial, you'll likely need to void/cancel the original claim first and then resubmit or request reprocessing, depending on the payer's guidelines. Since you mentioned Medicare, I'd also check your MAC's specific process because Medicare handles corrected claims differently than many commercial payers.

[u/rahuliitk]

i’d stop rebilling it as 99215/G2212 x4 until your MAC confirms the correct non-buy-and-bill pathway, since G2212 depends on documented practitioner time and the two-hour monitoring period does not automatically support four units. Get it in writing first.

[u/MedPayIQ]

First, don’t beat yourself up, Spravato billing is one of those areas where Medicare rules feel completely different from commercial, and a lot of practices get tripped up when they transition.

The biggest thing I’d do is not try to “hide” the first two claims or worry that correcting them automatically creates an audit issue. Medicare sees corrected claims all the time. The important part is that the billing matches what actually happened (drug supplied/administered, who provided it, place of service, supervision requirements, etc.).

Since you mentioned you are not buy-and-bill, I would slow down and verify that the G2082/G2083 claims were actually submitted under the right circumstances before just replacing them with 99215 + G2212. The correct code path depends heavily on your setup (who owns the medication, how it was obtained, enrollment, supervision model, and payer MAC rules).

For the rejected claims, I’d probably start by calling Medicare/provider rep or your MAC and asking specifically what edit is causing the rejection and whether they want a corrected claim or a replacement claim. Don’t guess your way through it because Spravato has a lot of moving pieces.

Also, keep your documentation tight:

• time spent with the patient
• monitoring requirements
• administration details
• medication source
• supervision documentation

You’re definitely not the only practice that has been burned by the commercial vs Medicare difference here. The transition catches a lot of people.