Insurance coverage
Medicare (Part B + Advantage)
Original Medicare Part B covers Spravato (esketamine) when administered in a REMS-certified site for treatment-resistant depression. Medicare Advantage (Part C) plans must cover it at least as well as original Medicare but often add step-therapy requirements. Off-label IV ketamine is generally not reimbursed by Medicare.
Coverage at a glance
| Modality | Status |
|---|---|
| Spravato (esketamine) | Covered |
| Ketamine IV infusion | Not covered |
| Ketamine IM injection | Not covered |
| Ketamine oral/lozenge | Not covered |
| Psilocybin (Oregon licensed) | Not covered |
| Psilocybin (Colorado licensed) | Not covered |
What the plan requires
- Diagnosis of treatment-resistant depression (documented trial of 2+ antidepressants)
- Administered only at REMS-certified site with 2-hour post-dose observation
- Prescribed by psychiatrist or mental health nurse practitioner
Practical tips
- Ask your clinic whether they bill Medicare directly (HCPCS codes S0013 and J3490) or whether you pay out of pocket and submit for reimbursement.
- Medicare Advantage PPO plans often have lower step-therapy hurdles than HMO plans.
- You will still owe 20% coinsurance under Part B unless you have a supplement (Medigap) plan.
Providers accepting Medicare
Always confirm in-network status with both the clinic and your plan before your first session.
No verified providers currently list Medicare. This can mean the plan is typically self-pay, or that we have not yet surfaced plan acceptance - check back as we expand clinic onboarding.