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

Anthem pays a median of $1,260.44 in Colorado for an 84 mg Spravato session (G2083). That one payment has to cover the drug, the visit and two hours of observation, but the drug alone costs about $1,290. For 7 in 10 Colorado prescribers in Anthem’s file, buying the drug and billing this code loses money on every 84 mg dose.

This comes from the October 2026 Colorado network file that covers the most Anthem plans, 1.3 gigabytes once unzipped. We kept dollar rates for professional claims in the office setting, since in a facility the drug is paid on the facility’s claim. We then kept the 1,303 psychiatrists and psychiatric nurse practitioners in the file who practice in Colorado and have an esketamine rate. A clinician listed under several plans at the same rate is counted once.

What Does Anthem Pay for Spravato in Colorado?

The medians are $862.26 for a session up to 56 mg, $1,260.44 for a session over 56 mg, and $16.30 per milligram of drug.

Rates from Anthem’s October 2026 Colorado machine readable file.

G2082 and G2083 pay for the visit, the drug and the two hours of observation in one payment. J0013 pays for the drug alone.

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

For 84 mg sessions, usually not. Pharmacies paid about $426 to $430 per 28 mg device as of September 30, 2026, according to the federal NADAC survey. That puts an 84 mg dose, three devices, at about $1,290 and a 56 mg dose, two devices, at about $853.

The two most common G2083 rates in the file are $1,260.44 and $1,071.37. Both fall short of an 84 mg dose, by about $30 and $219, before anything is paid for the visit or the observation. In all, 913 of the 1,303 prescribers with a G2083 rate have no rate that covers the drug.

The 56 mg code is closer. The median G2082 rate covers the drug with about $10 to spare, while the second most common rate, $733.23, falls about $120 short.

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

Can You Bill the Drug Separately With J0013?

Probably not if your practice buys the drug. Anthem’s Colorado coding tips from May 2022 tell practices that buy Spravato to bill G2082 or G2083 and not bill the drug separately. The tips predate J0013, which replaced the old drug code on January 1, 2026, and we found no newer version as of October 1, 2026.

Even so, Anthem lists a J0013 rate for 405 Colorado prescribers in the file. At the median of $16.30 per milligram, an 84 mg dose would pay $1,369.20, about $79 more than the drug costs. The visit and observation would then be billed on top. That is why it is worth asking Anthem in writing whether your contract allows it.

Should Colorado Practices Buy Spravato or Use a Specialty Pharmacy?

On most Anthem contracts in the file, the pharmacy route is safer for 84 mg patients. When a specialty pharmacy supplies the drug, the pharmacy bills Anthem for it and your practice bills the visit and observation. Buying the drug only makes sense in two cases:

• your G2083 rate is well above about $1,290, what the drug alone costs
• Anthem confirms in writing that you can bill the drug with J0013 and the visit with its own codes, since J0013 pays more than the drug costs at the median

Anthem’s Spravato rates in New York point the same way, with bundled rates below the drug’s cost. Practices that also offer TMS can compare Anthem’s TMS rates in Colorado, built from the same file.

What Does Anthem Require Before Approving Spravato?

Anthem asks for a poor response to the highest tolerated dose of two antidepressants in the current episode. That comes from its Spravato clinical criteria, published by CarelonRx and last reviewed February 21, 2025. Spravato can be used alone or with an antidepressant. The first approval lasts three months and renewals last 12 months. For depression with acute suicidal thoughts, the patient must also take an oral antidepressant. Every session must take place in a REMS-certified setting with two hours of monitoring.

How Does Colorado’s Step Therapy Law Apply to Spravato?

Colorado caps step therapy at one other drug for major depression on state-regulated plans. Under HB23-1130, effective January 1, 2025, the prescriber can also attest on a Division of Insurance form that an exception applies. One example is a patient who already stopped the required drug, or one in the same class, because it did not work. The plan must then cover the drug without step therapy.

Anthem’s criteria ask for two antidepressants, so the law matters when a patient has tried only one. It applies only to plans with “CO-DOI” on the member’s ID card. Two things are untested. Anthem may argue that two failed antidepressants are part of the definition of treatment-resistant depression, not a step. The law is also written for prescription drugs, and Spravato is often billed on the medical side. If a CO-DOI member is denied for having tried only one antidepressant, cite the law in the appeal.

How Does Health First Colorado Handle Spravato?

Health First Colorado has required prior authorization for J0013, G2082 and G2083 since July 1, 2026, and its bar is higher than Anthem’s. Its criteria, unchanged in the October 1, 2026 version, require two failed antidepressants from different classes, plus a failed add-on drug such as lithium or an atypical antipsychotic. Approvals last four weeks, then four more, then six months. Unlike Anthem’s tips, Health First Colorado lets practices bill the drug with J0013 and the visit with office visit codes instead of G2082 or G2083.

What This Means for Your Practice

Compare your own Anthem rates with these medians and with what you pay for the drug. If your G2083 rate is below your cost for an 84 mg dose, you are losing money on those sessions under buy-and-bill.

If your rates are low, the medians and the drug cost give you concrete numbers to bring to a rate request. A bundled rate that does not cover the drug is an easy case to make. Our guide to negotiating insurance contract rates covers how to make the 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 file behind this analysis unpacks to 1.3 gigabytes of raw pricing data that no spreadsheet can open. 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 focuses on a single payer and will not reflect rates from all available insurance options in Colorado. Fuse makes every effort to provide accurate and current information, but healthcare pricing and coverage policy change frequently, and individual circumstances affect actual payment. This information does not guarantee specific pricing. Practices should verify current rates and criteria directly with Anthem before relying on them for billing or negotiation decisions.