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Spravato Nasal Spray

Spravato®, also known as esketamine, nasal spray is a limited benefit for the treatment of treatment-resistant depression for beneficiaries 18 and older. An approval from Health Net Federal Services, LLC (HNFS) is required for all beneficiaries. Ketamine administered through subcutaneous, sublingual, IV, injectable, nasal spray, or orally is not a covered benefit. TRICARE follows the Centers for Medicare & Medicaid (CMS) billing guidelines for Spravato, which specify use of CPT® codes G2082-G2083 rather than E/M codes. See our Spravato Billing Tips page for more information.

To expedite the review process, providers may attach a Letter of Attestation in lieu of clinical documentation to the authorization request. 
Cost Information

Spravato® is a registered trademark of Janssen Pharmaceuticals Inc.
CPT® is a registered trademark of the American Medical Association. All rights reserved.