Guide to Integrating SPRAVATO® Treatment at Nebraska Peace of Mind Behavioral Health

Esketamine (SPRAVATO®) offers a powerful, evidence-based option for individuals living with treatment-resistant depression and acute suicidality. For many patients, it represents hope when traditional treatments have fallen short.

At Nebraska Peace of Mind Behavioral Health, incorporating SPRAVATO® as a dedicated service line allows us to expand access to life-saving, outpatient care while maintaining clinical excellence, safety, and sustainability.

Implementing SPRAVATO® requires careful attention to FDA REMS requirements, extended monitoring protocols, inventory controls, and complex billing and reimbursement considerations. This guide outlines how SPRAVATO® can be thoughtfully and safely integrated while protecting both patients and providers.

What this guide covers

  • What is SPRAVATO® (esketamine)?
  • Which patients are eligible for SPRAVATO®?
  • Treatment and monitoring protocols
  • Potential side effects
  • SPRAVATO® REMS requirements
  • Treatment space setup considerations
  • Billing and reimbursement guidance

What is SPRAVATO® (esketamine)?

SPRAVATO® is an FDA-approved intranasal medication containing esketamine, a rapid-acting antidepressant. It is indicated for adults with treatment-resistant depression and for depressive symptoms associated with acute suicidal ideation or behavior.

Which patients are eligible for SPRAVATO®?

  • Diagnosis of treatment-resistant depression or acute suicidality
  • Inadequate response to at least two prior antidepressant trials
  • Ability to participate in in-clinic treatment and monitoring
  • Continuation of an oral antidepressant during treatment

Careful screening and documentation are essential to ensure appropriate use and payer compliance.

Treatment and monitoring protocol

Induction phase

  • Twice-weekly treatments for four weeks

Maintenance phase

  • Sessions every one to four weeks based on clinical response

Patients must be monitored in the clinic for a minimum of two hours after each administration.

  • Patients may not drive or operate machinery same day
  • A physician or nurse practitioner must be on site
  • Staff must be prepared to intervene for adverse reactions

Potential side effects

  • Dizziness
  • Nausea
  • Anxiety
  • Increased blood pressure
  • Dissociation

Dissociation with intranasal esketamine is typically milder than IV or IM ketamine but still requires monitoring.

SPRAVATO® REMS program

The Risk Evaluation and Mitigation Strategy (REMS) program is required by the FDA to ensure safe use and minimize risks related to sedation, dissociation, and misuse.

  • Certification of the healthcare setting
  • Enrollment of prescribers, patients, and pharmacies
  • Secure medication storage
  • Mandatory post-administration documentation after each treatment

REMS compliance is one of the most time-intensive aspects of offering SPRAVATO® and requires reliable workflows.

Setting up the SPRAVATO® treatment space

  • DEA-compliant medication safe
  • Staff training on inventory management
  • Compliance with all regulatory requirements

Private room setup

  • Enhanced comfort and privacy
  • Greater personalization
  • Video monitoring required if multiple patients are treated simultaneously

Shared room with screens or partitions

  • Treat multiple patients simultaneously
  • No additional AV monitoring equipment needed
  • Cost-effective and flexible layout
  • Potential for peer-support elements

Couch or recliner setup

  • Increased comfort
  • More relaxed, home-like atmosphere

Additional environmental considerations

  • Soft lighting
  • Blankets and pillows
  • Sleep masks
  • Journals or quiet activities
  • Designated monitoring areas
  • Patient-selected music or curated playlists
  • Janssen-provided patient activity booklets

Billing and reimbursement considerations

Cost of SPRAVATO®

  • $700–$900 per 84 mg dose (average)
  • Pricing varies by distributor and volume
  • Some suppliers offer extended payment terms

Billing approaches

  • Buy-and-bill (practice purchases medication)
  • Pharmacy benefit via REMS-certified specialty pharmacy

Buy-and-bill guidance

  • G2082 (56 mg) or G2083 (84 mg) for Medicare and some commercial payers
  • S0013 units plus evaluation/monitoring codes for most commercial plans

Pharmacy benefit billing

  • E/M codes 99212–99215 based on physician involvement
  • 99417 for prolonged physician time
  • 99415–99416 for prolonged clinical staff services

Medicaid considerations

  • Reimbursement varies by state and provider type
  • NPs and PAs typically reimbursed at ~85% of physician rate
  • Verify eligibility and coverage prior to treatment
  • NDC requirements:
    • 56 mg: N450458-0028-02 (UN2)
    • 84 mg: N450458-0028-03 (UN3)

Technology and workflow support

Many practices rely on specialized EHR platforms and workflow tools to automate REMS submissions, streamline documentation, and manage prior authorizations—significantly reducing administrative burden.

Conclusion

SPRAVATO® is a major advancement in treating severe depression and suicidality. With a structured, compliant, and patient-centered approach, Nebraska Peace of Mind Behavioral Health delivers life-saving outpatient care while maintaining safety, integrity, and sustainability.