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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.

Providers should complete our Spravato Letter of Attestation and attach it 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.