Maintenance for Spravato, ketamine and TMS
After induction, Spravato (esketamine) moves from twice weekly for 4 weeks to weekly, then weekly or every other week. Ketamine starts with 6 infusions over 2 to 3 weeks, then boosters every 3 to 6 weeks. TMS (transcranial magnetic stimulation) starts with 30 daily sessions plus a 6-session taper. Plans reauthorize Spravato every 3 to 6 months.
Updated · Checked by the Covered Mind editorial team against cited sources
How often Spravato, ketamine and TMS are continued after the initial course, what insurers reauthorize, and how tapering works.
Key facts
- Last checked:
- Sources listed: 2
- Reading time: About 2 minutes
- Spravato induction: twice weekly for 4 weeks
- Ketamine induction: 6 infusions over 2 to 3 weeks
- TMS course: 30 daily sessions plus a 6-session taper
- Spravato reauthorization: every 3 to 6 months
| Fact | Value |
|---|---|
| Last checked | |
| Sources listed | 2 |
| Reading time | About 2 minutes |
| Spravato induction | twice weekly for 4 weeks |
| Ketamine induction | 6 infusions over 2 to 3 weeks |
| TMS course | 30 daily sessions plus a 6-session taper |
| Spravato reauthorization | every 3 to 6 months |
Check your plan in the coverage checker and read coverage rules by insurer. See the Spravato overview for the treatment schedule and answers to common questions.
Spravato
| Phase | Schedule |
|---|---|
| Induction | twice weekly for 4 weeks |
| Maintenance | weekly for weeks 5 to 8, then weekly or every other week from week 9 based on symptoms |
| Reauthorization | typically every 3 to 6 months with an updated score |
In the maintenance trial (SUSTAIN-1 trial: esketamine maintenance and relapse, JAMA Psychiatry 2019), stopping esketamine after remission roughly doubled relapse over the following months, which is why plans reauthorize continued treatment when a rating scale shows sustained response. For the records a reauthorization request needs, read How do I get Spravato approved by my insurance? Plans do not usually set a maximum duration but do require ongoing benefit.
Ketamine infusions
| Phase | Schedule |
|---|---|
| Induction | 6 infusions over 2 to 3 weeks |
| Maintenance | a booster when symptoms begin to return, commonly every 3 to 6 weeks at first, stretching to every 2 to 3 months |
Some clinics schedule fixed intervals; others treat on demand. Boosters are billed individually, so ask for the booster price separately from the series price. Questions to ask a Spravato, ketamine or TMS clinic lists the other price questions worth asking.
TMS
| Phase | Schedule |
|---|---|
| Initial course | 30 daily sessions plus a 6-session taper |
| Maintenance | not routinely covered |
| Reauthorization | re-treatment for relapse when the first course produced at least a 50 percent improvement |
Some plans allow a limited number of maintenance sessions after a documented response; ask before the taper ends. TMS: the complete guide covers the initial course in detail.
What belongs with a maintenance plan?
Every maintenance plan works better with the oral antidepressant continued (required for Spravato under most policies) and with psychotherapy, which has the best evidence for preventing relapse after any acute treatment.
When should treatment taper?
Discuss tapering after 6 to 12 months of sustained remission. The usual approach is stretching the interval rather than stopping abruptly, with a plan to resume quickly if symptoms return.
Related reading: Spravato: the complete guide and Ketamine therapy: the complete guide.
Sources
Related
Checked by the Covered Mind editorial team · · Editorial policy
Cite this
Covered Mind. "Maintenance for Spravato, ketamine and TMS." https://www.coveredmind.com/guides/maintenance-schedules. Last checked Sep 1, 2026.
This site provides general information about insurance coverage and treatment options. It is not medical advice, not a guarantee of coverage, and not a substitute for talking with a clinician or your health plan.