SPRAVATO Cost in 2026: Medicare Rates, Insurance, and Savings

2026 Medicare figures

What Medicare pays for one SPRAVATO visit in 2026

Medicare pays an office-based SPRAVATO treatment as one bundled code that covers the visit, the two-hour observation, and the medicine. The 2026 national amounts are $952.59 for G2082 and $1,356.08 for G2083.

CMS created the two codes in its 2020 physician fee schedule rule and describes them in the current code file as an office visit for an established patient “that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation” (G2082), or of “greater than 56 mg” (G2083). The national amount is the code's 2026 relative value multiplied by the $33.4009 conversion factor in the October 2026 release of the fee schedule.

Code	2026 national Medicare amount (office)	Your 20% after the deductible	What it pays for	Medicine price CMS built into the rate
G2082	$952.59	$190.52	Supervised visit, up to 56 mg, and 2 hours of observation	$834.20 (56 mg)
G2083	$1,356.08	$271.22	Supervised visit, more than 56 mg, and 2 hours of observation	$1,251.31 (84 mg)

Medicare adjusts the amount for where the office is. Novitas, the Medicare contractor for New Jersey, lists $1,102.53 (G2082) and $1,570.57 (G2083) for northern New Jersey and $1,039.03 and $1,479.63 for the rest of the state. Calculated from CMS's 2026 geographic cost indices, G2082 runs from $820.77 in Arkansas to $1,363.76 in the San Jose area. The medicine prices in the last column are the supply inputs listed in the 2026 final rule's practice-expense files; they explain why these visits cost far more than an ordinary office visit.

The first month: eight induction visits

The prescribing information schedules the induction phase twice a week for weeks 1 to 4, then the maintenance phase once a week for weeks 5 to 8. The prescriber chooses the dose, and the dose decides which code applies, so the table shows both ends of the range. It assumes Original Medicare, a participating clinician, and no supplemental coverage.

Visits	Medicare-approved total	You pay, deductible already met	You pay, none of the $283 deductible met
Weeks 1–4: 8 visits, all G2082	$7,620.72	$1,524.14	$1,750.54
Weeks 1–4: 8 visits, all G2083	$10,848.64	$2,169.73	$2,396.13
Weeks 5–8: 4 weekly visits	$3,810.36 (G2082) to $5,424.32 (G2083)	$762.07 to $1,084.86	Already met during weeks 1–4 in the same calendar year

How the arithmetic works: the deductible-not-met column is $283 plus 20 percent of the remaining approved amount. Medicare calculates the coinsurance claim by claim, so real statements can differ by cents. A Medigap or retiree plan may pay some or all of the 20 percent, and Medicare Advantage plans set their own copays and prior-authorization rules. Ask the plan which applies before the first visit.

Who supplies the medicine changes the bill

The 2020 rule states that when the clinician supervising the treatment does not also provide the esketamine, G2082 and G2083 cannot be billed; the visit and extended observation may instead be billed with existing office-visit and prolonged-service codes. In that case, ask who bills the medicine and under which benefit. Since January 1, 2026, the national code set has also included a drug-only code, J0013 (“Esketamine, nasal spray, 1 mg”), which CMS marks as not payable by Medicare. With a commercial plan, ask the center which codes it will bill and which benefit will process the medicine.

First calculation

Separate the medicine from the monitored treatment visit.

The number quoted for one part of care may not include the other services required on the treatment date.

SPRAVATO is administered in a certified healthcare setting, and the current prescribing information requires monitoring for at least two hours after each dose. The official coverage guide advises asking whether the medicine uses the medical or pharmacy benefit and whether the treatment visit uses the medical plan or a behavioral-health benefit. That split can change the network, deductible, claim, and cost questions you need answered.

Medicine

Benefit type, specialty-pharmacy or medical-claim route, deductible, copay, coinsurance, and plan quantity rules.

Administration and observation

Treatment-day clinical services, required monitoring, and any professional or observation charge.

Evaluation and follow-up

Psychiatric assessment, records review, outcome measurement, medication management, and later visits.

Facility and network

The treatment location, prescriber, facility, specialty pharmacy, and billing entity may not share one network status.

Treatment frequency

Total cost changes with the prescribed schedule, response, maintenance plan, and services billed at each visit.

Practical costs

Transportation, time away from work, caregiver support, and appointment or cancellation terms.

Coverage does not mean one universal rule

Current insurer policies show why a generic checklist can mislead.

Two current national policies both use prior authorization, but their documentation and timing are not identical.

The examples below were checked August 12, 2026. They are not a shortcut for the member's current plan document, and they do not establish whether a particular person qualifies.

Current policy example	What the policy illustrates	What the member still must verify
Cigna national formulary policy	For initial treatment-resistant-depression therapy, the policy lists diagnosis, documented antidepressant history, safety considerations, and specialist involvement; its stated approval period is six months.	The exact benefit plan, applicable policy version, required records, network, benefit route, authorization decision, and personal cost.
UnitedHealthcare commercial policy	The July 2026 policy lists diagnosis, baseline symptom measurement, documented treatment history, REMS-setting certification, and psychiatrist involvement; its stated authorization period is twelve months.	The exact member plan, state or employer variation, current criteria, reauthorization rules, network, claim route, and cost share.

Benefits call script

Ask for nine answers—not one yes or no.

Record the date, representative, reference number, exact plan, and exact treatment center for every answer.

Is the SPRAVATO medicine processed under my medical benefit or pharmacy benefit?
Which codes will the center bill: G2082 or G2083, or office-visit codes with the medicine billed separately?
Are the treatment visit, administration, and required observation billed separately?
Is the exact treatment center, prescriber, facility, and billing entity in network?
Is prior authorization required, and which current policy or criteria apply to my plan?
Which records must the treating clinician submit, and who owns the next action?
What deductible, copay, coinsurance, or other cost share applies to each billable part?
Does my estimate include the medicine, observation, evaluation, facility, and follow-up?
If coverage is denied or delayed, what is the written reason and appeal deadline?

Ask the treatment center for the names of every organization that may bill the plan before calling the insurer. A center can be certified under the SPRAVATO REMS and still be out of network for a particular member or service.

Printable real-cost worksheet

Build the estimate from the billable parts.

Keep completed health and insurance details with the insurer and care team. Advanced Depression Care does not collect them through this guide.

Health plan, plan type, and member-services number:

Exact treatment center, location, prescriber, facility, and billing entity:

Codes the center will bill (G2082, G2083, or office-visit codes with the medicine billed separately):

Medicine benefit route and in-network status:

Administration and observation benefit route and in-network status:

Evaluation, facility, and follow-up charges:

Prior-authorization policy, required records, owner, and reference number:

Deductible remaining for each applicable benefit:

Copay or coinsurance for medicine:

Copay or coinsurance for visit, observation, and facility:

Estimated number of visits in the current treatment plan:

Manufacturer or other assistance checked, eligibility, limits, and expiration:

Written total estimate and what could cause it to change:

Denial reason, appeal route, deadline, and next owner, if applicable:

Review official cost support

Savings programs

Apply assistance to the correct part of the cost.

The manufacturer currently separates medicine assistance from an observation rebate, and each program has its own rules and limits.

SPRAVATO withMe currently states that eligible commercially insured patients may pay as little as $10 per treatment for the medicine, subject to program requirements, quantity and annual limits, and terms that may change. That medicine program does not cover observation. A separate Observation Rebate Program currently says eligible patients may pay $0 after rebate for observation, with an annual limit and state exclusions. The program requirements state that the savings program is not for people who use any state or federal government-funded healthcare program, such as Medicare, Medicaid, TRICARE, the Department of Defense, or the Veterans Administration; those patients and uninsured or underinsured patients have different support routes. Confirm the current terms directly and do not treat an assistance estimate as insurance approval.

When authorization is denied

Turn the denial into a dated action plan.

A written reason tells the treating team whether the next step is a missing record, a policy criterion, a network issue, a benefit-routing problem, or an appeal.

1
Get the decision in writing
Record the reason, policy, date, reference number, and appeal instructions.
2
Match the reason to the responsible owner
The treating clinician addresses medical documentation; the coverage or billing team addresses benefit, claim, and network details.
3
Protect the deadline
Confirm who will submit the internal appeal, what additional information is needed, and the due date.
4
Ask about independent review
HealthCare.gov explains that external review may be available after an internal appeal, with an expedited route in qualifying urgent situations.
5
Keep clinical care separate from the insurance decision
Discuss safe interim care and appropriate alternatives with the clinician responsible for treatment.

Clinical and insurance limits

Coverage is not a treatment recommendation.

Insurance approval does not establish that SPRAVATO is appropriate for a particular person, and a denial does not independently decide the best clinical plan.

The current prescribing information includes boxed warnings and requires administration in a certified setting with post-dose monitoring. A qualified prescriber must assess diagnosis, treatment history, current medicines, risks, safety needs, and whether the treatment setting and follow-up plan fit the person.

Common cost and coverage questions

SPRAVATO insurance answers to verify

How much does SPRAVATO cost with Medicare?

In 2026, Original Medicare's national amount for one office treatment visit is $952.59 under code G2082 (up to 56 mg) or $1,356.08 under G2083 (more than 56 mg). Each amount covers the medicine, the visit, and the required two-hour observation. After the $283 Part B deductible, the usual 20 percent share is about $190.52 or $271.22 per visit. The amount is adjusted for where the office is, and supplemental or Medicare Advantage coverage changes what you pay.

How much does the first month of SPRAVATO cost?

The label schedules induction twice a week for weeks 1 to 4, which is 8 visits. At 2026 national Medicare amounts, 8 visits come to $7,620.72 if every visit is billed as G2082 and $10,848.64 if every visit is billed as G2083. With Original Medicare and no supplemental coverage, the patient share is about $1,524 to $2,170, or about $1,751 to $2,396 if none of the $283 deductible has been met. The prescriber sets the dose, which decides the code.

How much does SPRAVATO cost without insurance?

No national cash price is published. Two public reference points: Medicare's 2026 national amount for a treatment visit that includes the medicine is $952.59 or $1,356.08, and CMS priced the medicine alone at $834.20 (56 mg) and $1,251.31 (84 mg) when it built those 2026 rates. A center's self-pay price can be higher or lower; ask for a written, itemized quote per visit and for the first month.

Can Medicare patients use the $10 SPRAVATO withMe copay program?

No. The program requirements say it is not for people who use any state or federal government-funded healthcare program, including Medicare, Medicaid, TRICARE, the Department of Defense, and the Veterans Administration. The official support page lists a separate route for people with government coverage (Medicare, Medicaid, or military), which requires limited income and resources.

How much does SPRAVATO cost with insurance?

There is no reliable nationwide price with commercial insurance. Your amount can depend on whether the medicine and clinical services use the medical or pharmacy benefit, the deductible, copay or coinsurance, network, treatment schedule, facility charges, and any assistance for which you qualify. Ask the insurer and treatment center to verify each billable part in writing.

Is SPRAVATO covered by insurance?

Many health plans have a coverage pathway for eligible members, but coverage is not automatic and plan rules differ. The plan may require prior authorization, clinical documentation, a certified treatment setting, network participation, and other current criteria.

Does insurance cover the two-hour observation period?

Coverage and billing vary. Ask whether observation, administration, or facility services are separate from the medicine, which benefit processes each service, whether every billing entity is in network, and what cost share applies.

Does SPRAVATO require prior authorization?

Many plans use prior authorization, but the criteria and approval period can differ. The treating center should check the current policy for the exact plan rather than relying on a generic checklist or another insurer's rules.

Does prior authorization guarantee payment?

No. HealthCare.gov explains that preauthorization is not a promise that a plan will cover the cost. Network, eligibility, benefit terms, coding, site of care, and the services actually billed can still affect the final claim and patient responsibility.

What if insurance denies SPRAVATO?

Ask for the written reason, the policy criteria used, the internal-appeal instructions and deadline, and whether external review is available. Connect the next action to the treating clinician or coverage team, and discuss clinically appropriate care while the decision is being reviewed.

Can the SPRAVATO withMe program lower the cost?

The manufacturer currently says eligible commercially insured patients may pay as little as $10 per treatment for the medicine, subject to program requirements, limits, and changeable terms. That medicine program does not cover treatment observation; a separate observation rebate has its own eligibility and limits. Verify current terms directly before relying on either program.

Primary and official sources

Check the current label, program terms, and plan policy.

CMS, Novitas, Medicare.gov, and program figures were checked September 24, 2026. National Medicare amounts are calculated from the October 2026 relative value file; the locality range is calculated from the 2026 geographic practice cost indices. Official labeling establishes the approved product and safety pathway; it does not establish personal eligibility, coverage, network, or cost. Manufacturer support terms and insurer policies can change. Verify the exact plan and date directly before making a financial decision.