Yes. Cigna covers Spravato (esketamine) for treatment-resistant depression in Massachusetts when prior authorization criteria are met. Cigna's IP0220 policy is unusual in quantifying nonresponse: per Cigna, “Patient has demonstrated nonresponse (≤25% improvement in depression symptoms or scores) to at least two different antidepressants, each from a different pharmacologic class” (IP0220). Cigna does not require a specific rating scale; the documentation is left to the prescriber.
Across Lumin Health's 2026 commercial Spravato (esketamine) authorizations: 100% approval rate, with a median 4-day decision turnaround. Lumin Health's pre-submission medical-necessity review and standardized clinical documentation packet contribute to this outcome. Individual approval depends on plan-specific PA criteria — see Cigna's policy summary below.
Latest medical review on: May 5th, 2026. Medically reviewed by Instructor in Psychiatry at Harvard Medical School and Lumin Health Co-founder, Chief Medical Officer Dr. Ben Yudkoff.
Cigna covers Spravato (per Cigna Coverage Policy IP0220, Effective Date 2/1/2026):
Renewals are allowed when the patient continues to meet the Criteria and Dosing.
Massachusetts requires commercial insurers to cover mental health services on parity with medical/surgical benefits under Chapter 175 Section 47B and federal MHPAEA. This means Cigna cannot apply more restrictive prior authorization, visit limits, or cost-sharing to Spravato than to comparable medical treatments. For Massachusetts Medicaid (MassHealth) members, Spravato coverage follows the MassHealth Drug List criteria, which differ from commercial; Lumin Health verifies your specific plan at consultation.
Two Massachusetts statutes are particularly relevant when a commercial insurer reviews a Spravato prior authorization:
The “deemed granted” rule. Under 211 CMR 52.07, a Massachusetts commercial carrier that fails to respond to a complete prior authorization request within two business days is deemed to have granted the authorization. This applies to all major Massachusetts commercial carriers — Aetna, Blue Cross Blue Shield of Massachusetts, Cigna, Harvard Pilgrim Health Care, Mass General Brigham Health Plan, UnitedHealthcare, and the Group Insurance Commission's contracted carriers.
External review through the Office of Patient Protection. If your commercial insurer denies a Spravato authorization, you have the right to request external review by the Health Policy Commission's Office of Patient Protection (OPP). The filing window is four months from the final internal denial; OPP issues decisions within 45 days. Historically, more than 40% of OPP external reviews resolve in the patient's favor — an unusually patient-favorable rate compared with most states' insurance-department-administered review processes.
Lumin Health's Newton, Cambridge, Woburn, and Brookline locations handle Cigna Spravato authorizations end-to-end.
Spravato treatment at Lumin Health is available at all four Massachusetts locations: Newton, Cambridge, Woburn, and Brookline. All Lumin Health Spravato locations are REMS-certified per FDA requirements.
How Cigna compares with other major Massachusetts commercial payers on published Spravato prior authorization criteria:
Each linked cell opens the full Lumin Health Spravato coverage page for that payer.
Yes. Cigna requires prior authorization for Spravato (esketamine) in Massachusetts under Coverage Policy IP0220 (effective 2/1/2026). PA goes through Cigna's medical-drug benefit channel — submission criteria include documented nonresponse (≤25% improvement in depression symptoms or scores) to at least two prior antidepressants from different pharmacologic classes during the current major depressive episode. Lumin Health's PA team handles the submission packet — clinical documentation, baseline rating scale data, and prescriber attestation — directly with Cigna during your consultation.
Two from different pharmacologic classes, each used at therapeutic doses for at least 6 weeks in the current depressive episode, with documented nonresponse defined by Cigna as ≤25% improvement in depression symptoms or scores. Cigna does not name or require a specific rating scale.
6 months for TRD when criteria are met. Per IP0220, “Extended approvals are allowed if the patient continues to meet the Criteria and Dosing.”
Lumin Health handles everything on your behalf so you don't have to worry. If your prior authorization is denied, our team manages the appeal process directly with Cigna — you don't need to navigate the paperwork or follow-ups.
Cigna's IP0220 does not name or require a specific rating scale — the policy describes nonresponse as ≤25% improvement in “depression symptoms or scores,” with documentation left to the prescriber. In Lumin Health's clinical practice, we typically use validated scales (PHQ-9, MADRS, or HDRS) at every visit so your documentation is always ready.
Step 1 — File a Level 1 internal appeal. Deadline: 180 days from receipt of the Explanation of Benefits or initial denial notice (per Cigna: "Members can start the appeal process by submitting a written request to the address listed in plan materials within 180 days of receipt of the EOB."). Include the original denial letter, your prescriber's letter of medical necessity, your antidepressant trial history, and any standardized rating-scale documentation that supports the medical-necessity argument.
Submission. For medical-benefit Spravato denials: mail to Cigna Healthcare, P.O. Box 188062, Chattanooga, TN 37422. For behavioral-health-routed Spravato denials: mail to Evernorth Behavioral Health Central Appeals Unit, P.O. Box 188064, Chattanooga, TN 37422. Phone: the Member Services number printed on your Cigna ID card. If Cigna misses its response deadline: 1-800-882-4462.
Step 2 — Peer-to-peer (P2P) review. Your prescriber can request a peer-to-peer review by calling the Cigna utilization-review number listed in the denial letter, ideally before the appeal is filed. P2P is available pre-appeal and during the appeal review window.
Step 3 — Expedited (urgent) appeal. Federal urgent-care rules require Cigna to resolve expedited appeals within 72 hours. Call Member Services at the number on your ID card and explicitly request an expedited appeal; medical urgency must be documented by your prescriber.
Appeal levels. Most Cigna commercial plans provide a single internal appeal at the customer/member level, followed by the right to external review. Some plans and state markets layer a second internal level — verify on your specific plan summary.
Step 4 — External review. If the internal appeal is denied, you have the right to an independent external review. Massachusetts external review is administered by the Health Policy Commission's Office of Patient Protection (OPP). Filing window: 4 months from the final internal denial. Decision timeline: 45 days. See Massachusetts state-level patient protections above for the full pathway.
Spravato-specific caveat — read your denial letter carefully. Spravato is a REMS-restricted specialty drug. Cigna routes behavioral-health appeals through Evernorth Behavioral Health (the rebranded Cigna Behavioral Health). If your Spravato denial originated on the BH benefit (rather than the medical or specialty Rx benefit), the appeal goes to the Evernorth Central Appeals Unit address above. The exact appeal submission address differs depending on which benefit your plan uses — always confirm the address printed on your specific denial letter before mailing or faxing.
How Lumin Health helps. Lumin Health's prior-authorization team handles appeal submissions, peer-to-peer scheduling with the Cigna medical director, and assembles the clinical documentation packet — antidepressant trial history with dosing and duration, baseline and follow-up rating-scale data, prescriber attestation, and any state-specific exception arguments — to maximize the likelihood of overturning the denial.
Step 1 — File a Level 1 internal appeal. Deadline: 180 days from receipt of the Explanation of Benefits or initial denial notice (per Cigna: "Members can start the appeal process by submitting a written request to the address listed in plan materials within 180 days of receipt of the EOB."). Include the original denial letter, your prescriber's letter of medical necessity, your antidepressant trial history, and any standardized rating-scale documentation that supports the medical-necessity argument.
Submission. For medical-benefit Spravato denials: mail to Cigna Healthcare, P.O. Box 188062, Chattanooga, TN 37422. For behavioral-health-routed Spravato denials: mail to Evernorth Behavioral Health Central Appeals Unit, P.O. Box 188064, Chattanooga, TN 37422. Phone: the Member Services number printed on your Cigna ID card. If Cigna misses its response deadline: 1-800-882-4462.
Step 2 — Peer-to-peer (P2P) review. Your prescriber can request a peer-to-peer review by calling the Cigna utilization-review number listed in the denial letter, ideally before the appeal is filed. P2P is available pre-appeal and during the appeal review window.
Step 3 — Expedited (urgent) appeal. Federal urgent-care rules require Cigna to resolve expedited appeals within 72 hours. Call Member Services at the number on your ID card and explicitly request an expedited appeal; medical urgency must be documented by your prescriber.
Appeal levels. Most Cigna commercial plans provide a single internal appeal at the customer/member level, followed by the right to external review. Some plans and state markets layer a second internal level — verify on your specific plan summary.
Step 4 — External review. If the internal appeal is denied, you have the right to an independent external review. Massachusetts external review is administered by the Health Policy Commission's Office of Patient Protection (OPP). Filing window: 4 months from the final internal denial. Decision timeline: 45 days. See Massachusetts state-level patient protections above for the full pathway.
Spravato-specific caveat — read your denial letter carefully. Spravato is a REMS-restricted specialty drug. Cigna routes behavioral-health appeals through Evernorth Behavioral Health (the rebranded Cigna Behavioral Health). If your Spravato denial originated on the BH benefit (rather than the medical or specialty Rx benefit), the appeal goes to the Evernorth Central Appeals Unit address above. The exact appeal submission address differs depending on which benefit your plan uses — always confirm the address printed on your specific denial letter before mailing or faxing.
How Lumin Health helps. Lumin Health's prior-authorization team handles appeal submissions, peer-to-peer scheduling with the Cigna medical director, and assembles the clinical documentation packet — antidepressant trial history with dosing and duration, baseline and follow-up rating-scale data, prescriber attestation, and any state-specific exception arguments — to maximize the likelihood of overturning the denial.
