Dsuvia and Spravato Conditions of Payment
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This document states Alaska Medicaid coverage and billing conditions for Dsuvia and Spravato, including required settings, prior authorization requirements, administration supervision, and billing channel restrictions for providers serving Alaska Medicaid members.
No material clinical or coverage changes in this revision.
Coverage and Payment Conditions
Dsuvia coverage conditions
Coverage and billing conditions:
Bill through the appropriate institutional billing channel; do not submit via pharmacy POS.
Spravato coverage conditions
Coverage and billing conditions:
Prior authorization form: http://manuals.medicaidalaska.com/docs/dnld/Form_ServiceAuth.pdf
Bill through the appropriate institutional or professional channel; do not submit via pharmacy POS.
Drug Coding and Billing Details
| No codes listed |
Provider Requirements and Billing Restrictions
Prior authorization required for Spravato
Spravato requires prior authorization before billing; the Alaska Medicaid Service Authorization form is available at the Alaska Medicaid manuals site.
Dsuvia limited to hospital inpatient setting
Dsuvia is covered only when administered in a hospital inpatient setting and is not covered when administered in an outpatient setting.
Do not bill Dsuvia or Spravato through pharmacy POS
Dsuvia and Spravato may not be billed through the Alaska Medicaid pharmacy point-of-sale system; do not submit these products via pharmacy POS.
Minimum 2-hour direct supervision for Spravato administration
Spravato must be administered under the direct supervision of a healthcare provider for a minimum of 2 hours and continued until the patient is clinically stable.
Key Definitions
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