Esketamine: The Complete Clinical and Business Guide
Master the pharmacology, patient selection, REMS compliance, administration protocols, and practice setup for esketamine and build a specialized treatment program with confidence.
The Esketamine Prescribing Course was developed for nurse practitioners and advanced practice providers who want to offer esketamine (Spravato) for patients with treatment-resistant depression and major depressive disorder with acute suicidal ideation. This course covers everything from pharmacology and clinical trial evidence through patient screening, REMS requirements, side effect management, documentation, billing, and the full operational framework for building an esketamine practice.
5 CE Hrs (5 Rx Hrs) — Self-Paced Online — $499 Regular Price
Why This Course Matters
Treatment-resistant depression affects millions of Americans and remains one of the most clinically challenging presentations in psychiatric practice. For patients who have not responded to multiple antidepressant trials, options have historically been limited — until the FDA approval of esketamine (Spravato) in 2019. As the first intranasal antidepressant with a novel mechanism of action, rapid onset, and approval specifically for treatment-resistant depression and MDD with acute suicidal ideation, esketamine has opened a meaningful new treatment pathway for patients who have exhausted first and second-line options.
For nurse practitioners in psychiatric and mental health practice, offering esketamine represents both a significant clinical opportunity and a meaningful practice differentiator. But esketamine is not like other antidepressants. It requires REMS certification, mandatory in-office administration and two-hour post-dose monitoring, rigorous patient selection and prior authorization navigation, and detailed documentation for every treatment session. Without comprehensive training — clinical and operational — providers risk non-compliance, insurance denials, and clinical outcomes that fall short of what esketamine can deliver.
The Esketamine Prescribing Course was built to provide that training. Developed by a board-certified PMHNP who runs an active esketamine treatment program, this course gives NPs everything they need to offer esketamine effectively, compliantly, and profitably — from pharmacology and trial data through patient screening, side effect management, REMS compliance, billing mechanics, and practice setup.
Course Overview
The complete clinical and business framework for offering esketamine — from pharmacology through practice launch.
The Esketamine Prescribing Course covers the full scope of esketamine clinical practice and business development in one comprehensive program. The clinical guide covers mechanism of action, FDA indications, the complete clinical trial data set, dosing, contraindications, drug interactions, side effect management, patient selection, REMS requirements, administration protocols, suicidal ideation management, documentation, and case studies. The business guide covers REMS enrollment, practice and space setup, equipment, insurance credentialing, buy-and-bill mechanics, billing codes, prior authorization strategy, marketing, and staffing.
Whether you are building an esketamine program from scratch or formalizing and strengthening an existing one, this course gives you the clinical mastery, compliance infrastructure, and operational framework to offer esketamine at the highest standard — and sustain a specialized program that serves patients who have run out of other options.
What You'll Learn
Clinical
• Understand the mechanism of action of esketamine — NMDA antagonism, downstream glutamate release, neuroplasticity, and why it works differently from conventional antidepressants
• Apply both FDA-approved indications: treatment-resistant depression (TRD) and MDD with acute suicidal ideation (MDSSI)
• Evaluate the full clinical trial evidence, including Transform 1, 2, and 3, SUSTAIN, ESCAPE-TRD, and the monotherapy study — including effect sizes, response rates, and limitations
• Screen and select appropriate patients, including prior antidepressant trial requirements, contraindications, predictors of response, and co-occurring condition considerations
• Manage key adverse effects — blood pressure elevation, dissociation, nausea, and sedation — with specific clinical protocols for each
• Apply REMS requirements and documentation standards, including patient enrollment, lot number tracking, vital sign monitoring, and adverse event reporting
• Administer esketamine and manage patient experience, including pre-treatment protocols, setting, NPO requirements, and monitoring procedures
• Conduct suicidal risk assessment and manage suicidal ideation in the esketamine treatment setting
• Document accurately for REMS compliance, billing justification, and clinical continuity
Business
• Enroll your practice and patients in the Spravato REMS program and understand ongoing compliance requirements
• Set up a compliant esketamine treatment space, including appropriate controlled substance storage, disposal, and monitoring equipment
• Navigate insurance credentialing and prior authorization for esketamine, including common denial reasons and approval strategies
• Bill accurately using G2082, G2083, J0013, E/M codes (99213–99215), add-on time codes (99417, G2212), and monitoring codes
• Implement buy-and-bill mechanics through specialty distributors and understand the pharmacy vs. medical benefits distinction
Build referral channels and market your esketamine program to PCPs, therapists, inpatient teams, and the community
Curriculum
A complete clinical and business education for NPs building an esketamine treatment program.
Course Expires: 4/30/2029
The curriculum is organized into two integrated guides. The clinical guide builds from pharmacological foundations through trial evidence, patient selection, administration, and complex clinical management. The business guide covers everything required to set up, launch, and sustain an esketamine practice — from REMS enrollment through billing, prior authorization, and marketing. Case studies across both sections apply the content to real clinical and operational scenarios.
Instructional Approach
• Evidence-based pharmacology and clinical trial analysis at a level appropriate for prescribing practice
• Patient selection frameworks with detailed criteria for both TRD and MDSSI indications
• Protocol-level guidance for blood pressure management, dissociation, nausea, and suicidal ideation
• REMS compliance and documentation training grounded in real-world practice requirements
• Billing and coding instruction with worked case studies and PA template guidance
Clinical Guide — Modules
• What Is Esketamine? Mechanism, Pharmacology, and FDA Indications
• Clinical Trial Evidence: Transform 1, 2, and 3; SUSTAIN; ESCAPE-TRD; Monotherapy Data
• Dosing, Dosing Variables, Contraindications, and Drug Interactions
• Side Effect Profile: Blood Pressure, Dissociation, Nausea, Long-Term Risks
• Patient Selection: TRD vs. MDSSI, Ideal Candidates, Predictors of Response and Non-Response
• REMS Requirements, Patient Enrollment, and Pre-Screening Tools
• Pre-Treatment Protocols: Consent, Education, Setting, and Administration
• Monitoring Protocols: Blood Pressure Policy, Anti-Nausea Protocol, Dissociation Management
• Suicidal Risk Assessment and Managing SI in the Esketamine Setting
• Documentation, Charting Language, and Discharge Assessment
• What to Do When Esketamine Does Not Work
• Clinical Case Studies
Business Guide — Modules
• Pros, Cons, and Practice Considerations for Offering Esketamine
• Steps to Becoming a REMS-Certified Site
• Practice Setup: Space, Equipment, Controlled Substance Storage and Disposal
• Insurance Credentialing, Reimbursement Expectations, and Payer Considerations
• Billing: G2082, G2083, J0013, E/M Codes, Add-On Codes, and Monitoring Codes
• Buy-and-Bill: Specialty Distributors, Inventory, Ordering, and Payment
• Prior Authorization Strategy: PA Templates, Timelines, and Common Denial Navigation
• Marketing and Referral Development for Your Esketamine Program
• Hiring and Staffing Your Esketamine Practice
• Business Case Studies and Billing Scenarios
Why Practice Owners Choose This Course
The complete clinical and business framework for offering esketamine — built by a PMHNP who runs an active esketamine program.
This course is designed for NPs who want to offer esketamine not just competently, but operationally — with the clinical knowledge, compliance framework, billing strategy, and practice infrastructure to sustain a specialized program over the long term.
• Master the clinical science and trial data behind esketamine at the level needed for confident patient selection and treatment decisions
• Screen and select patients accurately, including navigating complex TRD histories, insurance requirements, and co-occurring conditions
• Manage the full side effect profile — blood pressure, dissociation, nausea — with specific protocols for each, including emergency response procedures
• Build a REMS-compliant esketamine practice from space setup and controlled substance storage through session documentation
• Bill esketamine services accurately and profitably using every available billing pathway — buy-and-bill, pharmacy benefits, and E/M coding
• Navigate prior authorizations, manage common denial reasons, and structure requests to maximize approval timelines
• Build referral channels that generate consistent patient volume from PCPs, therapists, inpatient teams, and the community
This is real-world education from a practitioner who built and operates an esketamine program — and knows what it takes for NPs to do the same.
Practice Impact
For You as a Provider
Develop the clinical expertise and operational confidence to offer esketamine as a fully integrated, REMS-compliant treatment in your practice — with the pharmacology, patient selection, protocol, and documentation skills to do it at the highest clinical standard.
For Your Practice
Build a specialized esketamine treatment program with the infrastructure, billing systems, compliance framework, and referral strategy to sustain and grow a high-value psychiatric service line that is meaningfully differentiated in your market.
For Your Patients
Expand access to one of the few FDA-approved treatments for treatment-resistant depression for patients who have tried everything else — and offer a rapid-onset option for patients with acute suicidal ideation who cannot wait weeks for conventional antidepressants to take effect.
Provider Outcome
Offer esketamine with clinical mastery, REMS compliance, and billing accuracy — and the operational foundation to build a program your patients can count on.
Upon completion, you will have the clinical knowledge, patient screening frameworks, side effect management protocols, REMS compliance systems, and business infrastructure to offer esketamine as a specialized treatment in your practice. The outcome is not just pharmacological knowledge. It is the ability to run an esketamine program with clinical rigor, compliance infrastructure, and billing efficiency — and to serve patients with treatment-resistant depression at the level their condition demands.
Common Use Cases
• Add esketamine as a specialized treatment service for patients with treatment-resistant depression who have failed multiple antidepressant trials
• Build an REMS-compliant esketamine program within an existing psychiatric NP practice
• Offer rapid intervention for patients with MDD and acute suicidal ideation (MDSSI indication)
• Navigate prior authorizations and insurance approvals for esketamine across pharmacy and medical benefit pathways
• Bill esketamine sessions accurately using G2082, G2083, J0013, E/M codes, and monitoring codes
• Develop referral relationships with PCPs, therapists, and inpatient teams to generate consistent esketamine patient volume
• Formalize and strengthen clinical protocols and REMS documentation for an existing esketamine program
Meet Your Instructor
Nick Goodwin is a Doctor of Nursing Practice and board-certified psychiatric mental health nurse practitioner with deep expertise in psychiatric pharmacology, treatment-resistant mood disorders, and the clinical and operational management of esketamine treatment programs. He is the owner of Goodwin Health Cafe, where he has developed and operates an active esketamine program serving patients with treatment-resistant depression and MDD with acute suicidal ideation.
His clinical focus includes advanced psychopharmacology, treatment-resistant depression, and the integration of emerging treatments — including esketamine and ketamine-based therapies — into evidence-based psychiatric NP practice. His curriculum for this course reflects the full complexity of real-world esketamine practice: the clinical nuance of patient selection, the operational demands of REMS compliance, the billing realities of a buy-and-bill model, and the practical protocols that make an esketamine program function at the clinical level it needs to.
Nick Goodwin
DNP, ARNP, PMHNP-BC
FAQs
Who is this course for?
This course is designed for nurse practitioners and advanced practice providers in psychiatric or mental health settings who want to offer esketamine (Spravato) for patients with treatment-resistant depression or MDD with acute suicidal ideation. It is especially valuable for NPs building a new esketamine program or looking to formalize and strengthen an existing one.
Do I need prescribing authority to take this course?
Offering esketamine requires NP prescriptive authority and enrollment of your practice site in the Spravato REMS program. This course prepares you for both the clinical requirements and the REMS enrollment process, and provides the full knowledge base needed to pursue certification and begin offering treatment.
What is the REMS program and does this course cover it?
The Spravato REMS (Risk Evaluation and Mitigation Strategy) is a mandatory FDA program that requires site enrollment, patient enrollment and consent, vital sign monitoring, documentation upload within 7 days of each session, and adverse event reporting. This course covers all REMS requirements in detail, including enrollment steps, session documentation standards, lot number tracking, and how to structure your practice for ongoing compliance.
What patients are appropriate for esketamine?
The course covers patient selection in depth, including the two FDA-approved indications — TRD (failure to respond to at least two antidepressants of adequate dose and duration in the current episode) and MDSSI (MDD with acute suicidal ideation or behavior). It covers contraindications, predictors of good versus poor response, how to accurately assess TRD history given the limitations of retrospective recall, co-occurring condition considerations, and pre-screening tools.
How does billing work for esketamine?
The course covers the full esketamine billing landscape, including G2082 (56mg, buy-and-bill), G2083 (84mg, buy-and-bill), J0013 (Medicaid and some commercial plans), E/M codes 99213–99215, add-on time codes 99417 and G2212, and monitoring codes 99415–99416. It also covers prior authorization timelines, pharmacy vs. medical benefits pathways, reimbursement expectations by payer type, and how to structure billing requests to maximize approval and reimbursement.
What is buy-and-bill for esketamine?
Buy-and-bill is the model where your practice purchases esketamine directly from a specialty distributor, administers it in your office, and bills the drug cost plus administration to insurance under the medical benefit. This course covers the full buy-and-bill process, including specialty distributor contacts, ordering mechanics, inventory management, controlled substance storage requirements, and billing submission.
What are the most common insurance denial reasons for esketamine?
The course covers the most common denial reasons, including insufficient depression severity documentation, bipolar vs. MDD diagnosis issues, active substance use or positive drug screens, inadequate prior antidepressant trial documentation, co-occurring conditions that require additional clinical justification, and failure to demonstrate prospective antidepressant trials. It also covers letter of medical necessity templates and how to structure clinical documentation to support approvals.
How do you manage blood pressure elevation during treatment?
Blood pressure elevation is the most common reason esketamine treatment is delayed or cancelled. The course covers a full blood pressure management protocol, including pre-treatment thresholds, 40-minute and 120-minute monitoring checkpoints, treatment-emergent hypertension response procedures, clonidine use, and when to refer to primary care for BP management before resuming treatment.
How do you manage dissociation during treatment?
Dissociation occurs in approximately 41% of patients. The course covers how to set patient expectations, how to respond when dissociation is severe or distressing, medication options for significant anxiety, and how to structure the treatment environment to support a therapeutic dissociative experience while maintaining patient safety.
What format is the course delivered in?
The course is delivered through self-paced online modules, allowing you to complete the clinical and business components on your own schedule and apply what you learn directly to building or strengthening your esketamine program.
How long will I have access?
Learners receive lifetime access to all course materials.
How many CE credits are included?
5 CE Hours — 5 Rx Hrs
What makes this course different?
Most esketamine education focuses either on pharmacology or on REMS compliance — not both, and almost never on the operational and billing realities of running a program. This course was developed by a PMHNP who owns and operates an active esketamine practice and covers the full picture: clinical science, patient selection, protocol-level side effect management, REMS compliance, documentation, billing mechanics, prior authorization navigation, and practice setup. It is the only course NP practice owners need to go from interest to a fully operational, compliant, and profitable esketamine program.