Spravato compliance risk scores, year on year

The 0–100 score

Most of the score reflects sessions per Medicare patient measured against the 56-session ceiling implied by the FDA esketamine label. The remainder comes from billing flags, weighted more heavily when they are hard flags such as same-day duplicate claims.

Bands: High, Elevated, Moderate, Low — High is 70 and above, Elevated 50 to 69, Moderate 25 to 49, Low below 25.

What it is not

It is not an audit finding, an accusation or a quality measure. Sicker panels, group NPIs that blend several prescribers, patients carried over from a prior year and CMS suppression all move the number without anything being wrong.

Read the flag guide or the full provider report for the detail behind each number.

What is the compliance risk score?

A 0–100 score built only from public CMS billing data. Most of it comes from how a provider's sessions per Medicare patient compare with the FDA esketamine label, and the rest from billing flags such as same-day duplicate claims or billing under a group NPI.

Does a high score mean a provider did something wrong?

No. A high score means the billing pattern sits far from label dosing or carries flags worth understanding. There are legitimate clinical and administrative explanations, including sicker panels, group billing that blends several prescribers and patients who started treatment in a prior year. Nothing here is evidence of wrongdoing.

Why do scores change between years?

Sessions per patient, patient counts and flags are recalculated for each data year independently. A score can move because dosing changed, because the patient panel grew or shrank, or because CMS suppressed part of the prior year's activity.

Why are some providers listed as new?

They appear in the latest data year but not the earlier one. That usually means a clinic started billing esketamine under Medicare Part B, or their earlier volume fell below the CMS suppression threshold of eleven patients.

What data is behind this page?

The CMS Medicare Physician & Other Practitioners by Provider and Service public use file, filtered to HCPCS codes G2082 and G2083 and aggregated by rendering NPI. Medicare Advantage, Medicaid and commercial payers are not included.