Anthem Blue Cross and Blue Shield Spravato Reimbursement Rates in Virginia (2026)

Anthem’s main Virginia employer network pays psychiatrists $1,287.46 to $1,358.99 for an 84 mg Spravato session, and $1,474.14 in Northern Virginia.

That one payment (G2083) has to cover the drug, the visit and two hours of observation. The drug alone costs about $1,288 at national pharmacy prices. Nurse practitioners are paid 85 percent of the psychiatrist rate, so 77 percent of them have no 84 mg rate on the main network that covers the drug.

How Much of Anthem’s Virginia Data Does This Cover?

Nearly all of Anthem’s commercial plans in Virginia. Anthem publishes 18 Virginia rate files for October 2026, and we read the 7 largest, 27 gigabytes of pricing data once unzipped. Of the 57,586 plans on Anthem’s Virginia list, 98 percent use only those 7 files. The other 11 are small files tied to particular employers, the largest listing 616 plans. Anthem does not publish enrollment, so these shares count plans, not members.

The 7 files cover Anthem’s HealthKeepers employer network, its HealthKeepers Select POS network, two smaller employer networks, and its individual plans, including those sold on the Virginia marketplace. Medicare Advantage and Medicaid plans are not in these files, since the federal rule behind them covers commercial plans only.

In those files, 1,998 psychiatrists, psychiatric nurse practitioners and clinical nurse specialists who practice in Virginia have a Spravato session rate. A rate in the file means the contract prices the code, not that the clinician offers Spravato. We matched each NPI against the federal NPPES registry and kept dollar rates for professional claims in the office setting. In a facility the drug is paid on the facility’s claim, and the professional rate there is about $28 to $36. A clinician listed at the same rate in several files is counted once in the medians.

What Does Anthem Pay for Spravato in Virginia?

The medians are $856.50 for a session up to 56 mg, $1,215.94 for a session over 56 mg, and $15.34 per milligram of drug.

CPT Code	Description	Mean Negotiated Rate	Median Negotiated Rate	Min	Max	Unique NPI Count
J0013	Esketamine (Spravato), nasal spray, 1 mg	$16.62	$15.34	$15.34	$34.59	1,964
G2082	Office visit with esketamine self-administration, up to 56 mg, including 2 hours of post-administration observation	$912.82	$856.50	$51.57	$2,272.75	1,998
G2083	Office visit with esketamine self-administration, over 56 mg, including 2 hours of post-administration observation	$1,295.21	$1,215.94	$51.57	$3,226.53	1,998

Rates extracted from Anthem Blue Cross and Blue Shield’s October 2026 machine readable files for Virginia, office setting, professional claims.

G2082 and G2083 pay for the visit, the drug and the observation in one payment. J0013 pays for the drug alone. The session medians blend networks that pay differently, and both happen to be what the small employer networks pay nurse practitioners.

Which Anthem Spravato Rate Do You Get in Virginia?

It depends on your license, where you practice, and which network the patient’s plan uses. Anthem’s main employer network, which most plans use, pays these amounts for an 84 mg session.

• Psychiatrists outside Northern Virginia. About 3 in 4 have one of three amounts, roughly by region. Around Richmond it is usually $1,287.46, in Hampton Roads $1,316.07, and around Roanoke and the Southwest $1,358.99.
• Psychiatrists in Northern Virginia. Two in three have a $1,474.14 rate. About 3 in 10 have a higher contract at $2,073.09.
• Nurse practitioners outside Northern Virginia. Nearly 9 in 10 have $1,094.34, $1,118.66 or $1,155.14, following the same regions.
• Nurse practitioners in Northern Virginia. 88 percent have a $1,253.02 rate.

Some clinicians have more than one rate, usually because they bill through more than one practice. By Northern Virginia we mean practice ZIP codes starting with 201 and 220 to 223, the same break our Anthem behavioral health rates in Virginia show for therapy codes. The 56 mg code follows the same pattern, at $906.88 for a Richmond-area psychiatrist and $770.85 for a nurse practitioner there.

The network moves the amount too. The HealthKeepers Select POS network pays the main network rates. The two small employer networks pay 9 to 11 percent more, $1,430.52 for most psychiatrists outside Northern Virginia and $1,215.94 for most nurse practitioners. Individual plans pay most clinicians 88.2 percent of the main network rate. This is the same pattern as Anthem’s TMS rates in Virginia, built from the same files.

Does Anthem’s Spravato Rate Cover What You Pay for the Drug?

For most psychiatrists, yes. For most nurse practitioners, no. Pharmacies paid about $427 to $429 per 28 mg device as of October 21, 2026, according to the federal NADAC survey. That puts a 56 mg dose (two devices) at about $854 and an 84 mg dose (three devices) at about $1,288.

The table takes the usual rate on Anthem’s main employer network and subtracts the drug. What is left is all you are paid for the visit and two hours of monitoring.

Clinician and region	56 mg session	84 mg session
Psychiatrist, Richmond area	$53 left	66 cents short
Psychiatrist, Hampton Roads	$73 left	$28 left
Psychiatrist, Roanoke and the Southwest	$103 left	$71 left
Psychiatrist, Northern Virginia	$184 left	$186 left
Nurse practitioner, Richmond area	$84 short	$194 short
Nurse practitioner, Hampton Roads	$66 short	$169 short
Nurse practitioner, Roanoke and the Southwest	$41 short	$133 short
Nurse practitioner, Northern Virginia	$28 left	$35 short

The patient’s network moves these numbers.

• Individual plans pay 88.2 percent of the main network rate. On an 84 mg session, a Richmond-area psychiatrist ends up $152 short, and nurse practitioners outside Northern Virginia $269 to $323 short.
• The two small employer networks pay 9 to 11 percent more. On an 84 mg session, most psychiatrists outside Northern Virginia have $142 left, while most nurse practitioners are still $72 short.

Over a first month of eight sessions, one at 56 mg and seven at 84 mg, the gaps add up. A Richmond-area nurse practitioner who buys the drug pays about $1,440 more for it than Anthem’s main network pays for all eight sessions. A Richmond-area psychiatrist has about $48 left, and that is the whole payment for eight visits with two hours of monitoring each.

Run your own numbers with your contracted rates and drug cost:

Can You Bill the Drug Separately With J0013?

Not if your practice buys the drug, according to Anthem’s Virginia coding tips for commercial plans, published May 2022. A practice that buys, gives and monitors Spravato should bill G2082 or G2083 alone, with no separate charge for the drug or the observation. When a pharmacy supplies the drug, the pharmacy bills for it and your practice does not.

If you do not bill G2082 or G2083, the tips say you may bill an office visit code (99202 to 99205 or 99212 to 99215). The prolonged-service code 99417 can be added only to 99205 or 99215.

Anthem still lists a J0013 rate for 1,964 Virginia prescribers, and almost all of them have the same $15.34 per milligram in every network. That pays $1,288.56 for an 84 mg dose, 44 cents more than the drug costs. So even if Anthem let you bill J0013 with office visit codes, you would earn what the pharmacy route pays, while carrying the cost of the drug yourself. The tips predate J0013, which replaced the old drug code on January 1, 2026, so confirm with Anthem in writing before billing it.

What Does Anthem Require Before Approving Spravato?

A poor response to the highest tolerated dose of two antidepressants in the current episode. That comes from Anthem’s Spravato clinical criteria, published by CarelonRx and last reviewed February 21, 2025.

• Diagnosis. Moderate to severe major depressive disorder in an adult.
• Medication history. Less than a 50 percent improvement on a standard rating scale after each of the two antidepressants.
• Approval length. Three months at first, then 12 months for maintenance if symptoms have improved by at least half.
• Suicidal thoughts. For depression with acute suicidal thoughts, the patient must also take an oral antidepressant, and approval lasts four weeks.

Spravato can be used alone or with an antidepressant. Every session must take place in a REMS-certified setting with two hours of monitoring. We read the criteria on October 21, 2026.

Can Virginia’s Step Therapy Law Help With Spravato Approvals?

It can on Virginia-regulated plans, if Anthem’s two-antidepressant rule counts as step therapy. Va. Code § 38.2-3407.9:05 requires insurers to grant exceptions for four reasons and respond within 72 hours.

The law has applied to plans issued or renewed since January 1, 2020. Insurers must post an exception process on their website. They must grant the exception when the prescriber’s documentation supports any of these.

• Contraindicated. The required drug is unsafe for the patient.
• Expected not to work. The required drug would be ineffective given what is known about the patient and the drug.
• Already tried. The patient tried the required drug under this plan or a previous one and stopped because it did not work, wore off or caused side effects.
• Already working. The patient is doing well on the drug you prescribed, under this plan or the one right before it.

Within 72 hours, counting weekends, the insurer must approve the request, deny it, or ask for more information. The limit is 24 hours in what the law calls exigent circumstances. Drug samples do not count as a trial of a required drug.

The last reason fits a common Spravato situation, a patient who responded under another plan and then switched to Anthem. The first three help when a patient has tried only one antidepressant for a good reason. Anthem may argue that two failed antidepressants define treatment-resistant depression rather than set a step, and the law does not settle that question. If a request is denied, cite the statute in the appeal.

The law reaches individual plans, fully insured employer plans and the Virginia state employee health plan. It does not reach other self-funded employer plans, which federal law governs, or Medicaid. We read the statute on October 21, 2026.

What This Means for Your Practice

Buy the drug only where your 84 mg rate clears its cost with room for the visit. On Anthem’s main network that means psychiatrists in Northern Virginia, around Roanoke and the Southwest, and psychiatrists whose patients are on the small employer networks.

Everywhere else, the specialty pharmacy route pays better.

• Nurse practitioners. Outside Northern Virginia, every common main network rate is $133 to $194 short on each 84 mg dose. Let the pharmacy supply the drug and bill the visit.
• Individual plan patients. At 88.2 percent of the main network rate, most 84 mg sessions lose money under buy-and-bill, whatever your license.
• Richmond-area psychiatrists. Your 84 mg rate covers the drug almost exactly, so buying earns nothing for the two hours of monitoring.

Anthem’s bundled rates fall short of the drug in other states too. Our Anthem Spravato rates in New York point to the pharmacy route, and most prescribers in Anthem’s Colorado file have no 84 mg rate that covers the drug.

Check your own rate against the drug cost in the calculator above, since about 3 in 10 Northern Virginia psychiatrists have a much higher $2,073.09 contract. If your rate falls short, a bundled rate below the drug’s cost makes a clear case for an increase, and our guide to negotiating insurance contract rates covers how to ask.

Once good rates are in place, Fuse helps make sure you actually get paid them. We check claims against your contracted rates and confirm each patient’s coverage before the first session. Reach out if you’d like to chat.

Disclaimer: This article uses rate information from the Machine Readable Files that Anthem Blue Cross and Blue Shield publishes under the federal Transparency in Coverage rule. These files are posted to satisfy the regulation, not to be read. The files behind this analysis unpack to 27 gigabytes of raw pricing data, and Fuse built its own software to extract and verify the figures above. Drug costs are national pharmacy averages and your own acquisition cost may differ. This analysis covers a single payer and will not reflect rates from all available insurance options in Virginia. Healthcare pricing and coverage policy change frequently, and individual circumstances affect actual payment. Practices should verify current rates and authorization requirements directly with Anthem before relying on them for billing or treatment decisions.