Does Medicare cover Spravato, and how much will I pay?
Yes. Original Medicare covers Spravato under Part B when you meet the FDA label criteria at a certified center, with no prior authorization. You pay 20 percent of the allowed amount after the Part B deductible, and most Medigap plans pay that 20 percent. Medicare Advantage plans add prior authorization and set their own copays.
Updated · Checked by the Covered Mind editorial team against cited sources
Key facts
- Last checked:
- Sources listed: 2
- Reading time: About 2 minutes
- Coinsurance: 20 percent of the Medicare allowed amount after the annual Part B deductible
- Medigap: A Medigap (Medicare Supplement) plan pays that 20 percent for most policy types
- Billing codes: G2082 (56 mg) or G2083 (84 mg)
- Advantage decision time: up to 14 days
| Fact | Value |
|---|---|
| Last checked | |
| Sources listed | 2 |
| Reading time | About 2 minutes |
| Coinsurance | 20 percent of the Medicare allowed amount after the annual Part B deductible |
| Medigap | A Medigap (Medicare Supplement) plan pays that 20 percent for most policy types |
| Billing codes | G2082 (56 mg) or G2083 (84 mg) |
| Advantage decision time | up to 14 days |
How Original Medicare and Medicare Advantage differ
Check your plan in the coverage checker and read Spravato coverage by insurer. For the session schedule and common questions in one place, see the Spravato overview. See Medicaid coverage by state for dual eligibility. Read how prior authorization works for Spravato for the submission steps.
Original Medicare
Spravato (esketamine) 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, at a certified center. In 2025 the label expanded to allow use on its own, although most insurers still require an oral antidepressant alongside it.
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 (Medicare and You handbook, Part B coinsurance). The allowed amount for G2083 is roughly $1,100 in 2026, so expect about $220 per session, or around $1,760 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.
How does Medicare Advantage cover Spravato?
Medicare Advantage plans must cover what Original Medicare covers, but they add prior authorization and set their own copays 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.
Which Spravato billing codes get denied?
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.
Does the Spravato copay program help with Medicare?
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 Spravato coverage by insurer for how plans differ.
Read Treatment-resistant depression: what the criteria actually mean and What to expect at your first Spravato session.
Related
Checked by the Covered Mind editorial team · · Editorial policy
Cite this
Covered Mind. "Does Medicare cover Spravato, and how much will I pay?" https://www.coveredmind.com/guides/medicare-and-spravato. 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.