Insurance Coverage
Does Anthem cover TMS therapy & Spravato?
What to expect from Anthem, the largest for-profit company in the Blue Cross Blue Shield association, now part of Elevance Health, when seeking coverage for TMS, Spravato (esketamine), or ketamine treatment.
TMS therapy coverage
Anthem covers TMS for adults with severe major depressive disorder when medication hasn't worked. Anthem's medical policy historically sets one of the higher bars among commercial insurers — often requiring documented failure of multiple antidepressant trials (including augmentation) plus psychotherapy.
Coverage applies to standard FDA-cleared rTMS protocols delivered at in-network facilities with prior authorization.
Spravato (esketamine) coverage
Anthem covers Spravato for treatment-resistant depression with prior authorization, administered at REMS-certified sites. Documentation of failed antidepressant trials and ongoing oral antidepressant treatment is typically required.
Ketamine therapy coverage
Like virtually all insurers, coverage for generic IV or IM ketamine for psychiatric use is rare because it's an off-label treatment. Portions of care (evaluations, monitoring visits) can sometimes be billed; the infusion itself is typically self-pay. Spravato is the covered alternative in the same drug family.
Prior authorization: what to know
- Prior authorization is required, and Anthem's documentation requirements are among the more demanding — gather complete medication history before applying.
- Anthem plans are state-specific (Anthem operates Blue plans in 14 states), so criteria can vary by state.
- If denied, appeal — Anthem denials for TMS are frequently overturned when full clinical records are submitted.
Frequently asked questions
Why was my Anthem TMS authorization denied?
The most common reasons are incomplete medication-trial documentation, missing psychotherapy documentation, or a depression severity score below the policy threshold. Your clinic can usually cure these gaps and resubmit or appeal.
Does Anthem cover maintenance TMS?
Anthem typically covers re-treatment for patients who responded to a prior course and later relapsed. Ongoing scheduled maintenance sessions are evaluated case by case and are less consistently covered.
Find a clinic that takes Anthem
Browse clinics offering these treatments and confirm insurance acceptance directly with the clinic:
Coverage guides for other insurers
This page is educational only and is not insurance or medical advice. Anthem plan terms control actual coverage. Verify benefits with the member services number on your insurance card, and see our general insurance guide for questions to ask.