Does G2082 require prior authorization?

No, G2082 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for G2082?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.70.

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`G2082`, Office or other outpatient visit for the evaluation and management of an

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.70

Facility

N/A

Non-Facility

N/A

Documentation Required

Enroll all treated individuals in the REMS registry to characterize risks and support safe use.
Evaluate therapeutic benefit at the end of the induction phase to decide on continuation of treatment.

Key Coverage Criteria

Treatment-resistant depression: induction weeks 1-4 — twice weekly dosing (day 1 start 56 mg; subsequent doses 56 mg or 84 mg); maintenance weeks 5-8 — once weekly (56 mg or 84 mg); from week 9 onward — every 2 weeks or once weekly (56 mg or 84 mg); individualize to the least frequent dosing to maintain remission/response.
Major depressive disorder with acute suicidal ideation or behavior: 84 mg twice weekly for 4 weeks (may reduce to 56 mg twice weekly for tolerability); use beyond 4 weeks has not been systematically evaluated.
Treatment-resistant depression: induction weeks 1-4 — twice weekly dosing (day 1 start 56 mg; subsequent doses 56 mg or 84 mg); maintenance weeks 5-8 — once weekly (56 mg or 84 mg); from week 9 onward — every 2 weeks or once weekly (56 mg or 84 mg); individualize to the least frequent dosing to maintain remission/response.
Major depressive disorder with acute suicidal ideation or behavior: 84 mg twice weekly for 4 weeks (may reduce to 56 mg twice weekly for tolerability); use beyond 4 weeks has not been systematically evaluated.
Treatment-resistant depression: induction weeks 1-4 — twice weekly dosing (day 1 start 56 mg; subsequent doses 56 mg or 84 mg); maintenance weeks 5-8 — once weekly (56 mg or 84 mg); from week 9 onward — every 2 weeks or once weekly (56 mg or 84 mg); individualize to the least frequent dosing to maintain remission/response.
Major depressive disorder with acute suicidal ideation or behavior: 84 mg twice weekly for 4 weeks (may reduce to 56 mg twice weekly for tolerability); use beyond 4 weeks has not been systematically evaluated.

4 Active Policies

BCBSIL-RX501.105, Esketamine Nasal Spray

BCBSMT-RX501.105, Esketamine Nasal Spray

BCBSNM-RX501.105, Esketamine Nasal Spray

BCBSOK-RX501.105, Esketamine Nasal Spray

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G2082, Office or other outpatient visit for the evaluation and management of an