Medicare and Spravato: what Part B pays and what you owe

Original Medicare

Spravato is a Part B service, not a Part D drug, because the clinic administers it. The clinic bills a bundled code, G2082 (56 mg) or G2083 (84 mg), that includes the drug and the two-hour observation. There is no national coverage determination; Medicare Administrative Contractors pay claims that match the FDA label: treatment-resistant depression or major depression with suicidal thoughts, an oral antidepressant, and a certified center. See the Medicare Spravato coverage page, the Spravato hub, the coverage checker, treatment comparisons and condition and treatment pages.

No prior authorization applies in Original Medicare. The clinic must still document the criteria in case of an audit.

Your cost

You pay 20 percent of the Medicare allowed amount after the annual Part B deductible. The allowed amount for G2083 is roughly ,100 in 2026, so expect about 20 per session, or around ,760 for the first month. A Medigap (Medicare Supplement) plan pays that 20 percent for most policy types, which is why many Spravato patients on Original Medicare pay little or nothing after the deductible.

Medicare Advantage

Medicare Advantage plans must cover what Original Medicare covers, but they add prior authorization and set their own copays, typically 0 to 50 per session as a Part B drug or specialist visit. Decisions take up to 14 days. Denials follow the same appeal path as any Medicare Advantage service, with a 60-day window.

Watch for billing mistakes

Some clinics bill the drug separately under J3490 with the observation code. That combination is often denied or underpaid. Ask the clinic whether it bills G2082 or G2083.

Manufacturer help

The manufacturer's copay program excludes Medicare and other federal plans. Independent foundations sometimes assist with Part B coinsurance for mental health treatment; the clinic's financial counselor will know the current ones.

See the Medicare Spravato coverage page for the summary and policy source.