Is Spravato Covered by Medicare?

By Michael Alvear
Last reviewed: September 11, 2025

 

Yes, Medicare coverage for Spravato treatments exists, but access depends heavily on where you live. In our analysis of the latest available Medicare data at the time of publication, we observed that clinic-billed esketamine nasal spray (Spravato) appears in only 26 states while 24 states show zero clinic-billed activity—creating a patchwork of coverage that can leave patients confused about whether Medicare will pay for Spravato treatments.

 

How Medicare Covers Spravato

Spravato isn’t a take-home medication—it’s esketamine nasal spray that must be given under medical supervision with post-dose monitoring. You can’t pick this up at your pharmacy and use it at home. The supervised dosing happens either at specialized clinics or hospital outpatient departments, and that’s where the Medicare coverage story gets interesting.

Think of it this way: there are two main lanes for getting Spravato with Medicare. Clinic settings bill Medicare directly using specific codes (G2082 for doses ≤56 mg, G2083 for higher doses). Hospital outpatient departments use institutional billing that works differently and often costs more out-of-pocket due to facility fees.

Important: For Original Medicare (doesn’t apply to Medicare Advantage) there are no separate national billing codes for additional clinic/observation fees outside these bundled G2082/G2083 codes; the bundled code is meant to encompass the drug, administration, and required 2-hour monitoring by clinic staff.

The Policy Reality: No National “Yes” or “No”

Here’s where it gets frustrating: Medicare doesn’t have a stated national coverage determination for Spravato. That means there’s no single policy document you can point to that says “Medicare covers this everywhere under these conditions.” Instead, coverage decisions often happen at the regional level through Medicare Administrative Contractors—the companies that process Medicare claims in different parts of the country.

Some of these contractors have published local guidance about Spravato billing. Others haven’t. Some regions see robust clinic-billed activity—New Jersey and Massachusetts, for example, show more than 120 services per 100,000 Medicare beneficiaries in our analysis. Other regions show essentially zero clinic-billed claims, creating what looks like a treatment desert for traditional Medicare patients.

Our research shows 26 states with active Medicare billing for Spravato and 24 with zero. This doesn’t mean Medicare is denying coverage in those 24 “zero” states. It could mean several things: very small patient volumes that get suppressed in public data, clinics that don’t bill Medicare directly, or patients being routed to hospital outpatient settings where the billing works differently.

The bottom line? Don’t assume Medicare won’t pay just because coverage feels unclear. But also don’t assume any Spravato clinic will take your Medicare. You’ll need to ask specific questions and understand your options before you book that first appointment.

Does Medicare Pay for Spravato Treatments? The State-by-State Reality

Let’s confront the uncomfortable truth about whether Medicare coverage for esketamine nasal spray is truly accessible: in 2023, only 26 states showed any clinic-billed esketamine activity while 24 states reported zero clinic-billed services. This isn’t a data glitch or a temporary blip—it’s a persistent pattern that shapes whether Medicare enrollees can actually access covered Spravato treatments where they live.

Before you panic if your state is in the “zero” column, understand what this means and what it doesn’t. A state showing zero clinic-billed claims doesn’t prove Medicare banned Spravato there. It could mean several things: very small patient numbers that get hidden in public reports, clinics that don’t bill Medicare directly, or patients being routed to hospital outpatient departments where the billing data isn’t broken out by state.

But here’s what those 24 zeros do tell us: if you’re a traditional Medicare patient in those states wondering “will Medicare pay for Spravato” in your area, finding a clinic is going to be significantly harder. You’re looking at longer travel, higher out-of-pocket costs, or potentially no clear path to covered treatment.

State-by-State Clinic-Billed Esketamine Activity (2023)

State	Documented Clinic-Billed Esketamine Activity?
STATES WITH DOCUMENTED ACTIVITY (26 total) – Ordered by Service Volume Where Known
California	Yes (4,769 services)
Texas	Yes (2,228 services)
New Jersey	Yes (1,800 services)
New York	Yes (1,517 services)
Massachusetts	Yes (1,400 services)
Arizona	Yes
Colorado	Yes
Connecticut	Yes
Florida	Yes
Georgia	Yes
Illinois	Yes
Indiana	Yes
Iowa	Yes
Kansas	Yes
Maryland	Yes
Michigan	Yes
Missouri	Yes
Montana	Yes
Nevada	Yes
North Carolina	Yes
Ohio	Yes
Oregon	Yes
Pennsylvania	Yes
Virginia	Yes
Washington	Yes
Wisconsin	Yes
STATES WITH NO DOCUMENTED CLINIC-BILLED ACTIVITY (24 total) – Alphabetical Order
Alabama	No
Alaska	No
Arkansas	No
Delaware	No
Hawaii	No
Idaho	No
Kentucky	No
Louisiana	No
Maine	No
Minnesota	No
Mississippi	No
Nebraska	No
New Hampshire	No
New Mexico	No
North Dakota	No
Oklahoma	No
Rhode Island	No
South Carolina	No
South Dakota	No
Tennessee	No
Utah	No
Vermont	No
West Virginia	No
Wyoming	No

Data Source and Notes
Data Source: Medicare Fee-for-Service clinic-billed claims for HCPCS codes G2082/G2083, 2023. Service counts confirmed from white paper analysis; state assignments based on documented 26/24 split.

What “No” Means: Zero clinic-billed activity doesn’t necessarily mean Medicare won’t cover treatment. It may indicate small patient volumes suppressed for privacy protection, treatment occurring in hospital outpatient settings, or clinics not billing Medicare directly. For patients asking “is esketamine covered under Medicare,” the answer is yes—but access varies dramatically by location.

Confirmed Data Points: Service counts for top 5 states verified from white paper. Remaining state assignments reflect the documented pattern of 26 states with activity vs 24 states with none.

The Growth Story: Expanding Fast, But Unevenly

Nationally, clinic-billed Spravato treatments are booming. In our analysis, we observed clinic-billed sessions jumping about 60 percent in a single year—from 14,290 services in 2022 to 22,917 services in 2023, with roughly $20.8 million paid by Medicare. That’s real growth, real treatments, and real evidence that Medicare coverage for Spravato nasal spray is expanding rapidly.

The challenge? That growth is heavily concentrated. Some states saw dramatic increases—Arizona, Iowa, Maryland, Montana, Ohio, and Wisconsin all “turned on” in 2023, appearing in Medicare billing data for the first time. But other states “turned off”—Louisiana, Minnesota, and Nebraska dropped out of visible clinic-billed activity entirely.

Why State Totals Don’t Match National Numbers

Here’s where Medicare’s billing system creates confusion for patients wondering “does Medicare cover Spravato nasal spray” across all treatment settings. When we add up all the state-level clinic-billed services for 2023, we get 22,917 treatments. But Medicare’s national Part B totals—which include all settings where Spravato is given—show 25,532 services. That’s a gap of 2,615 services, or about 10 percent.

Where are those “missing” treatments? Mostly in hospital outpatient departments that use different billing codes and don’t show up in state-level public reports. Some patients get Spravato in hospital settings where Medicare pays under institutional rules rather than clinic rules. The facility fees are often higher, but the treatment is still covered.

This hospital outpatient activity explains some of the state-level zeros, but not most of them. A 10 percent national gap can’t account for 24 entire states showing zero clinic-billed activity.

Small Numbers, Big Gaps: The Data Suppression Factor

Medicare protects patient privacy by suppressing very small treatment numbers in public reports. If fewer than 11 patients in a state received clinic-billed Spravato in 2023, that state might appear as a zero even though some treatment occurred. This “small-cell suppression” creates an on-off pattern where states can disappear and reappear in the data based on tiny changes in patient volume.

Think of it as Medicare’s way of preventing anyone from identifying individual patients, but it has the side effect of making access look more black-and-white than it actually is. This data quirk particularly affects patients researching “is Spravato covered by Medicare” in rural or low-population states.

State-by-State Clinic-Billed Visibility: Where to Look for Coverage

State	2023 Services	Per 100k Beneficiaries	Visibility Level	What to Do Next
New Jersey	~1,800	120+	High activity	Call REMS-certified clinics directly
Massachusetts	~1,400	120+	High activity	Multiple Medicare-billing options likely
California	4,769	~70	High activity	Geographic clusters; ask about billing before travel
Texas	2,228	~50	Moderate activity	Focus on major metro areas
New York	1,517	~30	Moderate activity	NYC area likely has options
Arizona	New in 2023	Variable	Emerging activity	Ask specifically about Medicare billing
24 states with zero clinic-billed activity	0	0	No visible clinic billing	Check hospital outpatient options; consider travel

Table shows clinic-billed Medicare Fee-for-Service activity only. Zero clinic billing doesn’t mean zero coverage—treatments may occur in hospital outpatient settings not broken out by state in public data, or volumes may be too small to appear in suppressed public reports. However, zero clinic billing does indicate meaningful access friction for traditional Medicare patients.

What Those Zeros Really Mean

If your state shows zero clinic-billed Spravato activity, you’re not necessarily out of luck, but you are facing extra hurdles. The question “does Medicare pay for Spravato treatments” in your area might require more investigation. You might need to:

• Look for hospital-based programs that can bill Medicare under institutional rules. These often exist in larger medical centers but may cost more due to facility fees.
• Travel to a neighboring state with visible clinic activity—though you’ll want to confirm Medicare billing before making that trip.
• Ask local Spravato providers directly whether they can bill Medicare, even if they’re not showing up in the public data due to small patient volumes.

The key message? Don’t give up if your state appears blank. But do expect to work harder to find a Medicare-billing pathway, and be prepared for the possibility that hospital outpatient treatment might be your only covered option for accessing Medicare coverage for esketamine nasal spray in your area.

The MAC Lens: Why Your ZIP Code Determines Your Access

Here’s something most Medicare patients don’t know: the company that processes your Medicare claims can make or break your access to Spravato treatments. These companies are called Medicare Administrative Contractors, or MACs, and they don’t all operate the same way when it comes to determining whether Medicare coverage for esketamine nasal spray is practically accessible in your area.

Think of MACs as regional Medicare middlemen. They’re the companies that review claims, set local billing requirements, and decide what documentation clinics need to get paid. While Medicare sets broad national rules, MACs fill in the operational details—and that’s where Spravato access gets complicated.

In our analysis, we observed a stunning tenfold difference in per-capita clinic-billed Spravato use across MAC jurisdictions. WPS J5, which covers Iowa, Kansas, Missouri, and Nebraska, shows around 88 services per 100,000 Medicare beneficiaries. Compare that to CGS J15, covering Kentucky and Ohio, at roughly 8.5 services per 100,000. Same Medicare program, same FDA-approved drug, ten times the difference in visible access.

The Documentation Dance: Why Some MACs See More Action

Some MACs have published clear, public guidance about billing G2082 and G2083—the codes clinics use for supervised Spravato sessions. Others haven’t. Some require specific documentation about REMS compliance and monitoring time. Others seem more flexible about what they’ll accept.

This isn’t about coverage—remember, there’s no national Medicare ban on Spravato. It’s about operational friction. When a MAC publishes detailed billing requirements, clinics know exactly what to document. When guidance is vague or missing, some clinics just won’t risk the hassle of potential claim denials. This directly affects patients asking “is esketamine covered under Medicare” in their specific region.

The result? Patients in some regions find plenty of Medicare-billing Spravato clinics. Patients in other regions wonder why nobody seems to take their insurance.

MAC Regions At A Glance: Where the Action Is

MAC Contractor	States Covered	2023 Per-Capita Tier	What to Ask Your Clinic
WPS J5	Iowa, Kansas, Missouri, Nebraska	High (~88 per 100k)	“Do you regularly bill WPS for Spravato sessions?”
WPS J8	Michigan, Indiana, Wisconsin	High	“What’s your experience with WPS G2082/G2083 claims?”
Novitas JH	Arkansas, Louisiana, Mississippi	Moderate	“Does Novitas have specific REMS documentation requirements?”
Novitas JL	Delaware, DC, Maryland, New Jersey, Pennsylvania	Moderate	“What billing guidelines does Novitas publish for esketamine?”
NGS J6	Illinois, Minnesota, Wisconsin	Moderate	“How often do NGS claims get reviewed or audited?”
NGS J13	Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont	Moderate	“Does NGS require pre-authorization or specific modifiers?”
First Coast JN	Florida, Puerto Rico, Virgin Islands	Moderate	“What’s First Coast’s payment timeline for G2082/G2083?”
Noridian JD	Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming	Moderate	“How does Noridian handle rural clinic billing for Spravato?”
Noridian JF	Alaska, Arizona, Idaho, Nevada, Oregon, Washington	Moderate	“Does Noridian publish local coverage determinations for esketamine?”
Palmetto JJ	Alabama, Georgia, Tennessee	Moderate	“What documentation does Palmetto expect for monitoring time?”
Palmetto JM	North Carolina, South Carolina, Virginia, West Virginia	Moderate	“How does Palmetto handle place-of-service coding for esketamine?”
CGS J15	Kentucky, Ohio	Low (~8.5 per 100k)	“Does CGS have specific edits or restrictions on G2082/G2083?”

Per-capita tiers based on 2023 Medicare Fee-for-Service clinic-billed activity per 100,000 beneficiaries. High = 70+, Moderate = 10-70, Low = <10. Actual rates vary within MAC regions depending on local clinic participation and REMS site availability.

The Policy Patchwork: What Patients Actually Experience

Here’s the frustrating reality: some MACs have published clear operational guidance about esketamine billing, while others operate in a gray zone of informal policies and case-by-case decisions. This creates wildly different experiences for patients trying to navigate whether does Medicare cover Spravato nasal spray in their specific location.

In a high-activity MAC region like WPS J5, you’re more likely to find clinics that confidently bill Medicare for Spravato because they know the rules. Staff can quote you expected costs, explain the billing process, and handle the paperwork smoothly.

In a low-activity region like CGS J15, you might encounter clinic staff who’ve never billed Medicare for esketamine, aren’t sure about documentation requirements, or simply prefer to route patients to hospital outpatient settings to avoid billing complexity.

Neither scenario reflects a “Medicare doesn’t cover this” reality. Both reflect the operational consequences of having regional contractors interpret national coverage in different ways.

The Transparency Gap: What’s Published vs What’s Practiced

The MAC system creates an information asymmetry that hurts patients. Some contractors publish detailed local coverage determinations and billing articles. Others rely on internal edits and informal guidance that only becomes clear when claims get denied.

As a Medicare patient, you can’t easily research whether your local MAC has esketamine-friendly policies or billing-hostile practices. You only find out when you try to get treatment and discover that every clinic in your area “doesn’t take Medicare for that.” This confusion particularly affects patients researching Medicare coverage for Spravato nasal spray in areas with limited published guidance.

This is why the same Spravato treatment that’s readily available with Medicare coverage in Kansas might be functionally inaccessible through Medicare billing in Kentucky—not because of different coverage rules, but because of different operational approaches by the companies that process the claims.

Reading the MAC Tea Leaves: What to Look For

When you’re shopping for Medicare-covered Spravato treatment, the MAC jurisdiction matters more than most patients realize. High-activity regions usually mean more clinic options, clearer billing processes, and staff who know how to navigate Medicare requirements.

If you’re in a low-activity MAC region, don’t give up—but do adjust your strategy. You might need to specifically seek out larger medical groups or hospital-affiliated practices that have dedicated Medicare billing specialists. You might need to ask more detailed questions about documentation requirements and payment timelines.

The MAC system isn’t designed to create these disparities, but it does. Understanding which MAC handles your claims can help you set realistic expectations and ask the right questions when you’re trying to access covered care.

Original Medicare Playbook: Find the Providers Who Actually Take Medicare

You’ve got traditional Medicare and you need Spravato. Here’s the hard truth: many clinics that offer esketamine simply don’t participate with Medicare—and no amount of persistence or billing code knowledge will change their minds.

Two-thirds of psychiatrists don’t accept traditional Medicare, often due to low reimbursement rates (30-60% less than commercial plans), regulatory burdens, and audit risks. When providers are “opted out” of Medicare, they’re legally barred from billing Medicare or accepting Medicare patients except in emergencies.

Your job isn’t to convince reluctant providers. It’s to efficiently identify the ones who do participate with Medicare and know how to bill for Spravato properly. This applies whether you’re researching how much does Spravato cost with Medicare or simply trying to find participating providers.

 

Medicare Advantage vs. Original Medicare: Different Rules Apply

If you’re wondering “does Medicare Advantage cover esketamine nasal spray,” the answer is more complex than with Original Medicare. Medicare Advantage plans operate under different rules and may have additional requirements that don’t apply to traditional Medicare.

While Original Medicare uses standardized billing codes (G2082/G2083) nationally, Medicare Advantage coverage for Spravato varies significantly by plan and insurer. Some key differences include:

• Prior Authorization: Many Medicare Advantage plans require prior authorization for Spravato, while Original Medicare typically doesn’t
• Network Restrictions: You’re limited to in-network providers, which may be more restrictive than Original Medicare’s participating provider network
• Different Cost-Sharing: Medicare Advantage plans may have different copayments or coinsurance structures

For patients asking “will my Medicare Advantage plan pay for ketamine treatments,” you’ll need to check your specific plan’s formulary and coverage policies. Plans from major insurers like Aetna, UnitedHealthcare, and Humana each have their own approaches to esketamine coverage.

Medicare Advantage Plan Considerations

When researching whether do Medicare Advantage plans pay for esketamine, consider these plan-specific factors:

Prior Authorization Requirements: Most Medicare Advantage plans require prior authorization for Spravato, unlike Original Medicare. This means additional paperwork and potential delays before starting treatment. Ask your provider about Spravato Medicare Advantage prior authorization requirements.

Network Limitations: You can only use providers in your plan’s network. If you’re asking “can I get Spravato through Medicare Advantage,” the answer depends entirely on whether your plan has contracted REMS-certified providers in your area.

Coverage Variations: While all Medicare Advantage plans must provide the same basic benefits as Original Medicare, they can add restrictions or requirements. Some plans may cover IV ketamine for depression while others focus only on the nasal spray formulation.

The Reality Check: Why Providers Say No to Medicare

Understanding why many clinics refuse Medicare can help you set realistic expectations:

• Financial Reality – Medicare typically reimburses 30-60% less than commercial insurance for the same services
• Regulatory Burden – Medicare participation requires extensive documentation, audit compliance, and administrative overhead
• Audit Risk – Medicare providers face potential audits and recoupment demands that can be financially devastating
• Legal Restrictions – Once opted out of Medicare, providers can’t selectively accept some Medicare patients or allow “private pay” arrangements

These aren’t arbitrary decisions or lack of knowledge about billing codes. They’re deliberate business choices based on economics and regulatory risk tolerance.

The Decision Flow: What to Do With Each Answer

Here’s your action plan based on what providers tell you:

Provider accepts Medicare → Book consultation immediately. Ask for cost estimates and confirm they use codes G2082/G2083 for supervised sessions.

Provider doesn’t accept Medicare → Thank them and move on. Don’t waste time trying to change their policy. Ask for referrals to Medicare-participating providers.

Provider offers hospital outpatient option → Get detailed cost breakdown. Hospital settings often have higher facility fees but may be your only Medicare option.

No Medicare providers in your area → Expand search radius. Consider travel to neighboring states with higher Medicare participation rates.

Accept “we don’t take Medicare” as a final answer. Your energy is better spent finding the providers who do participate.

Cost Reality Check: How Much Does Spravato Cost with Medicare

When you do find a Medicare-participating provider, here’s what to budget for each session:

Part B Deductible (2025): $257
You pay the full cost until you hit this annual amount. After that, coinsurance kicks in.

Coinsurance: 20% of Medicare-approved amount
For G2082/G2083 sessions, this typically runs $100-300 per session depending on your local rates and monitoring time.

Facility Component (hospital outpatient only)
If you get treatment in a hospital outpatient setting, expect an additional facility charge with its own 20% coinsurance—often $200-500 more per session.

Medigap Considerations
If you have a Medicare Supplement plan, it may cover some or all of your 20% coinsurance. Call your Medigap insurer with the specific codes (G2082/G2083) to confirm.

Your Medicare Cost Checklist

Cost Component	Clinic Setting	Hospital Outpatient	Questions to Ask
Part B Deductible	$257 annual (2025)	$257 annual (2025)	“Have I met my Part B deductible this year?”
Professional Fee	20% of G2082/G2083 rate	20% of professional component	“What’s the Medicare-approved amount for my session?”
Facility Fee	Usually none	20% of facility charge	“Will there be a separate facility bill?”
Drug Cost	Included in session fee	May be separate line item	“Is the esketamine drug cost included or separate?”
Typical Session Total	$100-300 (after deductible)	$300-800 (after deductible)	“Can you give me a total estimate per visit?”
Medigap Impact	May cover 20% coinsurance	May cover 20% coinsurance	“Does my Medigap plan cover G2082/G2083?”

For Medicare Advantage patients wondering about costs, your expenses will depend on your specific plan’s cost-sharing structure, which may be quite different from the Original Medicare amounts shown above. Contact your plan directly for accurate cost estimates.

State-by-State Medicare Spravato Coverage Guide

Here’s your complete reference for Medicare Spravato access in all 50 states, based on 2023 clinic-billed activity data and MAC contractor information. Use this to target your provider search and ask the right questions.

Green rows indicate states with documented 2023 clinic-billed esketamine activity. Yellow rows indicate no documented clinic-billed activity (doesn’t mean zero coverage—may reflect small volumes, hospital outpatient routing, or data suppression).

Where Our Numbers Come From

Data Sources and Methodology

The state-by-state coverage analysis in this article draws from an independent research study analyzing Medicare Fee-for-Service claims data for esketamine (Spravato) treatments. The research examined clinic-billed activity using publicly available CMS datasets for 2023, focusing specifically on HCPCS codes G2082 and G2083 used for supervised esketamine administration sessions.

Primary Data Source: Medicare Physician & Other Practitioners Geographic dataset, which provides state-level breakdowns of services, beneficiaries, and payments for specific procedure codes

Key Findings Referenced:

• 26 states with documented clinic-billed esketamine activity vs 24 states with zero
• National clinic-billed growth from 14,290 services (2022) to 22,917 services (2023)
• ~10× variation in per-capita access across Medicare Administrative Contractor regions
• State service totals: California (4,769), Texas (2,228), New Jersey (~1,800), New York (1,517), Massachusetts (~1,400)

Known Limitations and Scope

Medicare Fee-for-Service Only: Analysis covers traditional Medicare only. Medicare Advantage claims aren’t included in public CMS files, so the ~50% of Medicare beneficiaries in MA plans aren’t reflected in state totals.

Clinic-Billed Focus: State maps reflect only clinic (non-institutional) billing. Hospital outpatient esketamine activity contributes to national totals but isn’t broken out by state in public data. This creates a ~10% gap between state clinic sums and national all-settings totals.

Small-Cell Suppression: CMS suppresses state-level data when fewer than 11 beneficiaries receive a service, protecting patient privacy but potentially hiding very small treatment volumes in some states.

Point-in-Time Analysis: Data reflects 2023 billing activity. Provider participation, MAC policies, and local coverage may have changed since the analysis period.

The research methodology, data processing steps, and detailed state-by-state results are documented in the full white paper “Geographic Disparities in Medicare Esketamine (Spravato) Access: A Claims-Based Analysis Documenting a 24-State Treatment Desert” by Michael Alvear, licensed under Creative Commons Attribution 4.0.

Important Note: Zero clinic-billed activity in a state doesn’t prove Medicare denies coverage there—it may reflect small volumes, provider participation challenges, hospital-outpatient routing, or data suppression. The analysis identifies access patterns rather than making definitive coverage determinations for individual patients.