Medicare Advantage claims now using G codes for Spravato

When billing Spravato^® (esketamine) for dates of service on or after Aug. 23, 2021, use one of the following HCPCS codes for Medicare Plus Blue℠ and BCN Advantage℠ members: 

• G2082: Office or other outpatient visit for the evaluation and management of an established patient who requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self-administration; includes two hours post-administration observation
• G2083: Office or other outpatient visit for the evaluation and management of an established patient who requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg of esketamine nasal self-administration; includes two hours post-administration observation

This change is based on Centers for Medicare & Medicaid Services coding guidelines and applies only to Medicare Plus Blue and BCN Advantage members.

What’s not changing
Don’t use these G codes when billing Spravato claims for Blue Cross Blue Shield of Michigan commercial or Blue Care Network commercial members. Instead, when billing for those members, continue to do the following:

• Use S0013 for dates of service on or after Jan. 1, 2021.
• Use J3490 or J3590 for dates of service prior to Jan. 1, 2021.

Prior authorization information
As a reminder, you must request prior authorization for Spravato using the NovoLogix^® online tool when it’s administered in outpatient settings for members with the following coverage:

• Blue Cross commercial
  Note: Blue Cross and Blue Shield Federal Employee Program^® members and UAW Retiree Medical Benefits Trust non-Medicare members don’t participate in the standard prior authorization program. Refer to the Specialty Pharmacy Prior Authorization Master Opt-in/out Group List to determine whether other Blue Cross groups participate in the standard prior authorization program.
• Medicare Plus Blue
• BCN commercial
• BCN Advantage

Using NovoLogix
NovoLogix offers real-time status checks and immediate approvals for certain medications. 

If you have access to Provider Secured Services, you already have access to enter authorization requests through NovoLogix.  If you need to request access to Provider Secured Services, complete the Provider Secured Access Application form and fax it to the number on the form. 

Additional information
For more information on requirements related to drugs covered under the medical benefit, see the following documents:

• For commercial members, see the Blue Cross and BCN utilization management medical drug list for Blue Cross PPO (commercial) and BCN HMO (commercial) members document.
• For Medicare Advantage members, see the Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue PPO and BCN Advantage members document.