HCPCS code G2082: Outpatient Visit, Established Patient, Up to 56 mg of Esketamine Nasal Self-Administration

Learn more about the proper billing and coding of HCPCS code G2082 with our short guide that has a list of documentation and billing requirements.

Use Code

## **What is HCPCS code G2082?** HCPCS code G2082 is a temporary code established by the Centers for Medicare and Medicaid Services, maintained by the American Medical Association (AMA), for the administration of a nasal spray for the treatment of depression. Its code description is as follows: "Office or other outpatient visit for the evaluation and management of an established patient that 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 2 hours post-administration observation." This code bundles the drug administration and the professional services (evaluation, management, and observation) into a single code. It is used for patients with treatment-resistant depression (TRD) or major depressive disorder with suicidal thoughts or actions, in conjunction with an oral antidepressant. To be more specific, it covers: - An office or other outpatient visit for an established patient - Evaluation and management (E/M) service - The supervision of a physician or other qualified health care professional - The provision of up to 56 mg of esketamine nasal self-administration - Two hours of post-administration observation.

## **HCPCS code G2082 documentation requirements** Thorough and accurate documentation is essential for billing with G2082. Key requirements include: - The patient must be an established patient and meet the diagnostic criteria for a major depressive episode - Both the healthcare setting and the patient must be enrolled in the SPRAVATO Risk Evaluation and Mitigation Strategies (REMS) program. - Documentation must clearly demonstrate the medical necessity for the esketamine treatment. - The medical record must document the direct supervision of the esketamine self-administration by a qualified healthcare professional or healthcare provider and the required two-hour post-administration observation period. - The documentation should support the E/M service provided during the visit, including a medically appropriate history and/or examination.

## **G2082 billing requirements** Billing for G2082 requires careful attention to specific guidelines: - G2082 is a bundled code that covers both the drug and the professional services. - For Medicare claims, the KX modifier is required with G2082. - The appropriate ICD-10 diagnosis codes (e.g., F32.2, F33.2) that support the medical necessity of the treatment must be used. - While CMS established the G-codes, other payers may have their own specific policies. It's crucial to check with individual payers (e.g., commercial insurance) to confirm their coverage and billing requirements for esketamine administration. - G2082 is specifically for doses up to 56 mg. For doses greater than 56 mg, the appropriate code is G2083.

## **Other relevant codes** A related code to G2082 is G2083 or "Office or other outpatient visit for the evaluation and management of an established patient, specifically when it requires the supervision of a physician or other qualified health care professional, and includes the administration of greater than 56mg of esketamine nasal spray (SPRAVATO®) for self-administration, along with at least two hours of post-administration observation."

Frequently asked questions

No, G2082 is specifically for an established patient.

No. G2082 is a bundled code that includes the cost of the drug. Billing for the drug separately would be considered improper billing.

The two-hour observation period is included in the G2082 code. If a patient requires prolonged observation or a separate E/M service before or after the administration, you should check with the payer's specific policies, as this may not be covered or may require different coding.