Does TRICARE cover TMS therapy & Spravato?

TMS therapy coverage

TRICARE covers TMS for major depressive disorder when medically necessary — generally for beneficiaries whose depression hasn't responded adequately to antidepressant medication. Care can be delivered at military treatment facilities with TMS programs or by TRICARE-authorized civilian providers.

Active-duty service members need a referral and authorization through their military treatment facility; other beneficiaries follow their plan's referral rules (Prime requires referrals; Select generally doesn't, though preauthorization for TMS still applies).

Spravato (esketamine) coverage

TRICARE covers Spravato for treatment-resistant depression with prior authorization at REMS-certified facilities, typically requiring documented antidepressant failures and concurrent oral antidepressant treatment.

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

• Preauthorization is required for TMS under both Prime and Select.
• Active-duty members should start with their military treatment facility's behavioral health department, which coordinates referrals to civilian network providers when needed.
• VA care is a separate system — veterans using VA health care access TMS through VA medical centers, many of which now operate TMS programs.

Frequently asked questions