Insurance Coverage
Does Cigna cover TMS therapy & Spravato?
What to expect from Cigna, a global health services company covering more than 18 million U.S. medical customers, when seeking coverage for TMS, Spravato (esketamine), or ketamine treatment.
TMS therapy coverage
Cigna covers TMS for adults with major depressive disorder that hasn't responded to antidepressant medication. Cigna's coverage policy generally requires documented failure of antidepressant trials at adequate dose and duration during the current episode, and confirms the absence of seizure-risk contraindications.
Cigna processes many behavioral-health authorizations through Evernorth, its health services arm — your clinic will know the pathway.
Spravato (esketamine) coverage
Cigna covers Spravato for treatment-resistant depression with prior authorization through its pharmacy and medical policies, at REMS-certified sites, typically alongside an ongoing oral antidepressant.
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 for TMS and Spravato on essentially all Cigna plans.
- Cigna typically wants a current standardized depression score and complete medication history with doses and durations.
- Authorizations are usually issued for an initial block of sessions with the remainder approved after a progress review.
Frequently asked questions
How long does Cigna prior authorization take for TMS?
Standard determinations typically come back within 5–15 business days once complete records are submitted. Expedited review is available when your provider certifies urgency.
Does Cigna cover a second course of TMS?
Yes, generally — patients who showed meaningful response to a prior course and have relapsed are commonly approved for re-treatment, with documentation of the earlier response.
Find a clinic that takes Cigna
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. Cigna 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.