Buy and Bill vs. Assignment of Benefits (AOB) for Spravato
When administering Spravato® (esketamine) under the medical benefit, mental health practices typically choose between two reimbursement models:
Buy and Bill
Assignment of Benefits (AOB)
Understanding the differences between these models is essential for protecting cash flow, minimizing administrative burden, and ensuring uninterrupted patient access to care.
At Prime Healthcare Billing & Consulting, we help practices select and implement the Spravato billing strategy that best aligns with their financial capacity, staffing, and payer mix.
Quick Overview: Buy and Bill vs. AOB
Feature Buy and Bill Assignment of Benefits (AOB)Medication Ownership Practice owns medication Specialty pharmacy owns medication Upfront Cost High None Inventory Risk Practice assumes risk Pharmacy assumes risk Billing Responsibility Drug + services Services only Administrative Load Higher Lower Best For High-volume, established practices Smaller or newer Spravato programs
What Is Buy and Bill for Spravato?
Buy and Bill is a provider-directed reimbursement model. Your practice purchases Spravato upfront, administers it in-office, and then submits claims to the payer for reimbursement.
How Buy and Bill Works
Order Spravato from an authorized specialty distributor
Receive and securely store medication per REMS requirements
Administer Spravato to the patient
Submit claims for the drug and administration services
Receive reimbursement (typically 30–90 days later)
Your practice carries the financial risk during the period between purchasing the medication and receiving payment.
Advantages of Buy and Bill
Full control over scheduling and dosing
Immediate treatment availability
Potentially higher reimbursement, depending on payer structure
Streamlined workflow once processes are established
Challenges of Buy and Bill
Significant upfront capital investment
Inventory tracking and expiration management
More complex billing and documentation
Higher exposure to denials if coding is incorrect
Buy, and Bill is most successful when supported by an experienced behavioral health billing infrastructure.
What Is the Assignment of Benefits (AOB) for Spravato?
With the Assignment of Benefits, a REMS-certified specialty pharmacy supplies Spravato and bills the patient’s insurance directly for the medication.
Your practice:
Does not purchase the drug
Bills only for administration and monitoring services
This model shifts medication cost and inventory risk away from the provider.
Advantages of Assignment of Benefits
No upfront medication costs
Reduced financial risk
Simplified billing (services only)
Ideal for lower-volume or startup Spravato programs
Challenges of Assignment of Benefits
Requires patient consent and AOB agreements
Potential delays if pharmacy or payer approvals lag
Less control over medication logistics
Reimbursement amounts depend heavily on payer policy
Coding Differences: What Changes by Model?
Buy and Bill Coding
Depending on payer requirements, claims may include:
Medicare / Some Commercial Payers (Bundled Codes)
G2082 – ≤56 mg dose (includes drug, E/M, and 2 hours observation)
G2083 – >56 mg dose (includes drug, E/M, and 2 hours observation)
Commercial Payers (Separate Billing)
J0013 – Esketamine nasal spray (1 mg = 1 unit)
56 mg = 56 units
84 mg = 84 units
E/M codes (99202–99205, 99212–99215)
Prolonged service codes when applicable
Always confirm payer-specific requirements before submission.
Assignment of Benefits Coding
Because the pharmacy bills for the medication, your claims include services only:
Appropriate E/M code based on time or medical decision making
Prolonged services when time exceeds E/M thresholds:
99417 (commercial) or G2212 (Medicare) for physician time
99415 / 99416 for prolonged clinical staff time
You may not bill physician and staff prolonged services on the same date
When to Choose Buy and Bill
Buy and Bill is often the better option if your practice:
Has strong cash reserves
Treats a high volume of Spravato patients
Wants full operational control
Has billing systems capable of handling complex drug claims
When to Choose Assignment of Benefits
AOB is often ideal if your practice:
Wants to avoid upfront drug costs
Has limited storage capacity
Is starting a Spravato program
Prefers simplified billing workflows
REMS & Compliance (Applies to Both)
Regardless of billing model, all practices must:
Maintain Spravato REMS certification
Document administration, monitoring, and time accurately
Retain records for audits and payer reviews
Verify payer policies before treatment
Key Financial Considerations
Buy and Bill requires significant working capital and cash flow planning
AOB minimizes financial exposure but may introduce scheduling dependencies
Reimbursement rates vary by payer and billing structure
Some practices successfully use both models, depending on payer rules
Final Takeaway
There is no universal “best” Spravato billing method—only the one that fits your practice’s financial structure, staffing, and payer mix.
Established, high-volume practices often benefit from Buy and Bill
Smaller or growing practices often succeed with Assignment of Benefits
Many practices maintain flexibility by supporting both
At Prime Healthcare Billing & Consulting, we help behavioral health practices:
Evaluate payer policies
Implement compliant Spravato workflows
Reduce denials and cash-flow disruptions
Need help determining the right model for your practice?
Talk with a Spravato billing expert and let us handle the complexity—so you can focus on patient care.
