Does TRICARE cover TMS or Spravato? A military family’s guide to care access

For military families, health care is often tied to your current assignment and the status of the service member. If you’ve just moved because of a Permanent Change of Station (PCS), maybe to a post like Fort Stewart, or if a family member’s activation status, like a National Guard or Reserve member, has changed due to being called to active duty, navigating TRICARE can feel like learning a whole new language. 

One of the most complex areas is getting specialized mental health care. You may be exploring advanced, innovative treatments like transcranial magnetic stimulation (TMS) or Spravato® (esketamine) nasal spray. 

This guide is here to provide clarity on TRICARE coverage for these services. We want to help you understand your benefits, especially as you navigate the complexities of the TRICARE East, managed by Humana Military, and TRICARE West, managed by TriWest Healthcare Alliance regions. 

Mental health and the military family

Military life requires huge sacrifices from service members and their families, and these can lead to mental health challenges. Moving often, dealing with deployments and managing high stress can cause or worsen problems like depression. 

It’s important to remember that asking for help is a sign of strength, not weakness. The need for quality mental health care within the military community is significant. Major depressive disorder (MDD) is common among service members and veterans. Roughly 13% of people aged 12 years and older in the U.S. have reported symptoms of depression. For the military community, access to timely, effective care is critical to unit readiness and family well-being. 

When traditional treatments like psychotherapy and medication aren’t enough, advanced options become essential. 

Transcranial magnetic stimulation (TMS) coverage

TMS is a gentle treatment that doesn’t involve surgery. It uses targeted magnetic pulses to stimulate the areas of the brain that regulate mood. Many people choose TMS because it works powerfully without the full-body side effects that medicines can cause. 

Does TRICARE cover TMS?

Yes, TRICARE usually covers TMS therapy for people who have been diagnosed with major depressive disorder (MDD) when certain health rules are met:

• Eligibility

You must usually be 18 years or older, though some recent updates may extend coverage to adolescents 15 and older in some regions, like TRICARE West, so always verify your specific policy. The main rule is that you have MDD and the depression didn’t get better after trying two or more different antidepressant medications, taken for a minimum amount of time and at a minimum dose, or if you can’t handle the side effects of those medications. 

• Prior approval

TRICARE requires prior authorization, a preapproval, for TMS treatment before you start your sessions. Your doctor will send the proper documentation to the regional contractor, Humana in the East and TriWest in the West, to get this approval. 

• In-network doctor or clinic

To pay the least amount, you should always choose a doctor or clinic that is in network with TRICARE. Psychiatry Treatment Centers is proud to be an in-network provider for both TRICARE East and TRICARE West at our locations in Georgia and California, respectively. 

• Status changes

If a National Guard or Reserve member is activated, their rules for care may change depending on the length of their orders. Active-duty members and their families generally need a referral and preapproval from their primary care provider for all specialist care, including TMS. Always check your TRICARE benefits after a status change. 

• Cost

What you pay for TMS treatment depends on your specific TRICARE plan: Prime, Select, Reserve Select, etc. 

Spravato® (esketamine nasal spray) coverage

Spravato® is a nasal spray medication given in a certified clinic to treat severe depression. It works on brain pathways differently from older medications and is known for acting quickly.

Does TRICARE cover Spravato®?

Yes, TRICARE covers Spravato® for specific health problems and under strict guidelines. 

1. Eligibility

Coverage is mainly for adults, 18 years or older, diagnosed with treatment-resistant depression (TRD) or major depressive disorder (MDD) with acute suicidal ideation or behavior. Like TMS, you must provide documentation showing that your symptoms have failed to respond to at least two different antidepressant medications. 

• Prior approval

TRICARE requires prior authorization for Spravato®. Prior authorization must include all required papers: diagnosis, failed medication trials and clinic REMS certification (more on this below), before treatment can begin. 

• Clinic requirement

Spravato® must only be administered in a certified clinic because you have to be monitored for at least two hours after each dose. The provider and the clinic must be part of the FDA’s Risk Evaluation and Mitigation Strategy (REMS) program. TRICARE will not pay for treatment if the clinic is not REMS certified. 

• No off-label or compounded use 

TRICARE does not cover Spravato® for conditions that the FDA has not approved, which is considered off-label use. It also doesn’t cover custom-made versions of esketamine or ketamine sold by some clinics. 

• Cost 

Your personal cost will depend on your TRICARE plan. TRICARE coverage significantly lowers the cost for those who qualify. 

Psychiatry Treatment Centers provides compassionate care for military families

Navigating TRICARE, especially after a PCS move or a change in status, can be frustrating. We understand that you’re not just seeking a benefit; you’re seeking true healing for yourself or a loved one. 

Psychiatry Treatment Centers is proud to help support the brave service men and women and their families, who serve in a different but equally vital way. We are happy to work directly with the TRICARE East and TRICARE West regional contractors. 

Whether you’re in the TRICARE West region at one of our clinics in California, or in the TRICARE East region, like at our location in Hinesville, Georgia, we support Fort Stewart families, and we offer kind, professional care.

In addition to TRICARE, we also accept CHAMPVA in support of the spouses, dependents and survivors of veterans.

We can help you navigate the benefit checks and approval paperwork to make the process easier, so you can focus on what matters most: getting better. 

Reach out to our team by phone today for more information or to schedule an initial appointment. You can also book your initial appointment online now.