Insurance Coverage
Does Medicare cover TMS therapy & Spravato?
What to expect from Medicare, the federal program covering adults 65+ and many people with disabilities, when seeking coverage for TMS, Spravato (esketamine), or ketamine treatment.
TMS therapy coverage
Medicare covers TMS for major depressive disorder nationwide through its regional contractors' local coverage determinations. The core requirement is a confirmed MDD diagnosis with documented failure of antidepressant medication in the current episode — typically at least one to four trials depending on the regional policy, with many regions also recognizing medication intolerance.
Original Medicare pays 80% of the approved amount after the Part B deductible; a Medigap supplement typically covers the remaining 20%. Medicare Advantage plans must cover TMS comparably but add network and prior-authorization requirements.
Spravato (esketamine) coverage
Medicare covers Spravato for treatment-resistant depression as a Part B medical benefit when administered at a REMS-certified site. Standard Part B cost-sharing applies; government-insured patients aren't eligible for the manufacturer copay card.
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
- Original Medicare doesn't use prior authorization for TMS in most regions — the clinic certifies medical necessity and documentation at billing.
- Medicare Advantage plans almost always require prior authorization; the clinic submits it.
- Documentation of your medication history is still essential — claims can be denied retroactively without it.
Frequently asked questions
How much does TMS cost with Medicare?
With original Medicare alone, you pay 20% coinsurance after the Part B deductible — often $1,000–$2,500 across a full course depending on regional rates. With a Medigap supplement, out-of-pocket cost is often near zero. Medicare Advantage costs depend on your plan's copay structure.
Does Medicare cover TMS for OCD or anxiety?
Medicare's coverage determinations for TMS center on major depressive disorder. Coverage for OCD is emerging in some regional policies but is not yet uniform — your clinic can check the current local coverage determination for your region.
Find a clinic that takes Medicare
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. Medicare 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.