Spravato Reimbursement in Austria: Case-by-Case (2026)

Not routinely — and it is worth being honest about this from the first sentence: Spravato (esketamine) is not in Austria's outpatient reimbursement code (EKO). The drug is authorized and genuinely used for treatment-resistant depression, but public funding runs through two narrower doors: inpatient treatment is covered through hospital financing, and outpatient treatment is covered only with case-by-case approval from your sickness fund's chief physician. This page explains how each route works, what you pay when neither opens, and how to give an approval request its best chance; the eligibility decision itself always sits with a clinician, and you can begin orienting yourself with our eligibility check.

What is covered

Spravato is EMA-authorized for treatment-resistant depression, but Austria has not placed it in the routine outpatient reimbursement list, so access follows two funding logics:

Inpatient: if you are treated on a psychiatric ward, esketamine is funded like the rest of your care through the hospital financing system (LKF). Coverage is part of the hospital stay, and the hospital's own psychiatric team decides whether esketamine belongs in your plan.
Outpatient: outside hospital walls, whether your sickness fund pays is decided case by case by the fund's chief physician (chefärztliche Bewilligung). Approvals are real but not guaranteed — which is why many Austrian patients end up paying privately.

Who qualifies

The clinical criteria are the EU label criteria: adults whose current moderate-to-severe depressive episode has not responded to at least two antidepressants, with esketamine taken together with an SSRI or SNRI and administered under direct supervision with post-dose observation. For the outpatient funding route, the file that decides the case is your documented treatment history — substance, dose, duration and outcome for every antidepressant tried in the current episode. Assemble it before anything else.

Who decides and how to apply

There is no single national gatekeeper; the setting decides who decides. For the hospital route, ask your GP or psychiatrist for a referral to a hospital psychiatric service — in Vienna, the treatment-resistant depression outpatient service at AKH Wien, the university hospital of the Medical University of Vienna, is the best-known specialist port of call. For the outpatient route, your psychiatrist submits the chief-physician request to your sickness fund; you cannot file it yourself, so the working relationship with a psychiatrist who supports the treatment is the real starting point. The full picture of every legal route is in our Austria access guide; to compare listed practices, browse providers in Austria.

What it costs you

If you are covered — as an inpatient via LKF, or as an outpatient with an approval — treatment is funded within that route. Without approval, Vienna's private market publishes its fees: at Dr. Buchmayer's practice a first consultation is EUR 400 and an esketamine session EUR 150–250; at PsyTherapie a session is EUR 350, or EUR 450 combined with psychotherapy. Because these are Wahlarzt practices, your sickness fund refunds part of each invoice — PsyTherapie indicates a typical refund of EUR 80–110 per session. Ask for a written per-course total and the exact refundable items before starting; the partial refund is a legal entitlement, not a favour.

If you do not qualify

In Austria this section is really about working the case-by-case route properly, then falling back honestly:

File the chefärztliche Bewilligung before committing to self-pay. Your psychiatrist submits it, and it stands or falls on your documented treatment history. A refusal costs you nothing but time; an approval changes the economics of the whole course.
Consider the inpatient door. If your situation warrants ward-level care, esketamine within a hospital stay is covered through LKF — a question to put to the assessing hospital team, not a workaround to engineer.
Private Wahlarzt practices are the self-pay fallback at the fees above, softened by partial refunds. Screening quality varies — see our clinic-choice guide.
Clinical trials are free by definition. Recruiting Austrian studies include a psilocybin study in depression with anhedonia at the Medical University of Vienna and the INTENSIFY trial with a site at the Medical University of Innsbruck — see the trials guide.

Frequently asked questions

Is Spravato reimbursed in Austria?

Not routinely. It is not in the outpatient reimbursement code (EKO). Inpatient use is covered through hospital financing (LKF); outpatient coverage needs a case-by-case chefärztliche Bewilligung from your sickness fund, and many patients pay privately.

What is a chefärztliche Bewilligung and how do I get one?

It is the sickness fund's chief-physician approval for a treatment outside routine coverage. Your psychiatrist files it, and it stands or falls on your documented treatment history — every antidepressant tried in the current episode, with dose, duration and outcome.

How much does private esketamine treatment cost in Vienna?

Per the practices' published schedules: a first consultation at EUR 400 and sessions at EUR 150–250 at Dr. Buchmayer's practice; EUR 350 per session, or EUR 450 with psychotherapy, at PsyTherapie — minus a typical Wahlarzt refund of EUR 80–110 per session.

Why does Austria work this way when Germany simply covers it?

Germany placed esketamine in a label-following statutory system; Austria left it out of the routine outpatient code, so funding runs through hospital financing and individual approvals instead. See the Europe-wide reimbursement map for the full comparison.

Sources

This guide is for general information only and is not medical advice, a diagnosis, or a recommendation of any treatment. Regulations and reimbursement rules change; always verify current requirements with your insurer and discuss your options with a licensed clinician who knows your history. If you are in crisis, contact your local emergency number or a crisis line immediately.

This guide awaits review by a licensed medical professional.

Is Spravato Reimbursed in Austria? The Case-by-Case Reality (2026)

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