Does Medicare cover Spravato in Arizona?
Yes. Medicare Part B generally covers Spravato given at a certified clinic. Here’s what it covers, what you may pay, and how Medicare Advantage differs.
For Medicare members in Phoenix, Scottsdale, Mesa, Tucson, Flagstaff, Prescott, and across Arizona.
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The short answer
Original Medicare covers Spravato (esketamine) under Part B when it’s given at a REMS-certified clinic for treatment-resistant depression or major depressive disorder with suicidal thoughts or actions. The visit, dose, and two-hour observation are billed together.
Under Original Medicare you typically pay 20% coinsurance after the Part B deductible. A Medigap (Medicare Supplement) plan may cover some or all of that. Medicare Advantage plans must cover it too, but often add prior authorization or step-therapy rules.
What Medicare looks for
Based on CMS billing and coding guidance for esketamine. Medicare Advantage plans may add requirements.
- Treatment for an FDA-approved use: treatment-resistant depression, or major depressive disorder with suicidal thoughts or actions
- Given at a healthcare site certified in the Spravato REMS program
- Medical records that support the diagnosis and the need for treatment
- Medicare Advantage: often prior authorization and documented trials of at least two antidepressants
Different criteria apply to depression with acute suicidal thoughts. If you are in crisis, call or text 988.
How to get started
Know your Medicare type
Original Medicare (with or without Medigap) or a Medicare Advantage plan. The rules differ.
Find a clinic that accepts it
Choose a certified Spravato clinic that accepts Medicare, or is in network with your Advantage plan.
Evaluation
A prescriber confirms Spravato is right for you and documents your history.
Plan your rides
You can’t drive until the next day after a restful sleep, so arrange transportation for each visit.
The manufacturer’s Spravato withMe savings program can’t be used with Medicare.
Other insurers
Have a different plan? See Spravato coverage by insurer, or find a Spravato clinic near you.
Sources: CMS Medicare Coverage Database, Billing and Coding article A59249 (esketamine); Janssen Spravato payer coverage and reimbursement (spravatohcp.com), including HCPCS G2082/G2083; FDA Spravato prescribing information (2025).
Arizona guides
Clear answers to the questions people ask before choosing a clinic.
Guides
Spravato coverage by insurer
Care by city
Medicare & Spravato questions
Does Medicare cover Spravato?
Yes. Medicare Part B generally covers Spravato given at a REMS-certified clinic for its FDA-approved uses.
How much does Spravato cost with Medicare?
Under Original Medicare you typically pay 20% coinsurance after the Part B deductible. A Medigap plan may reduce or cover that. Medicare Advantage costs depend on your plan.
Does Medicare Advantage cover Spravato?
Medicare Advantage plans must cover what Original Medicare covers, but they often require prior authorization and proof that other antidepressants were tried first.
Can Same Team help Medicare members?
Yes. Our navigation call is free and open to everyone, including Medicare members. Please note that Same Team’s separate coaching services are not covered by Medicare.
Not sure where to start?
Schedule a navigation call and a Same Team navigator will help you understand your options and find care that fits.
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