Is Ketamine Therapy Covered by Insurance? What Patients Need to Know

As ketamine therapy gains popularity for treating mental health conditions like treatment-resistant depression, anxiety, PTSD, and OCD, many people ask:

Is ketamine treatment covered by insurance?

The short answer is: It depends—on the form of ketamine, the insurance provider, and the condition being treated.

This guide explains when insurance companies are likely to cover ketamine therapy, the difference between FDA-approved treatments and off-label use, and what you may need to pay out-of-pocket.

What Is Ketamine Therapy?

Ketamine treatment involves administering the drug in controlled medical settings—usually as IV infusions, nasal spray, or intramuscular injections—to treat mood disorders, chronic pain, and more.

• IV ketamine therapy and ketamine infusions are typically used off-label for mental health treatment
• Spravato® (esketamine), a nasal spray, is FDA-approved for treatment-resistant depression and covered by insurance in many cases

What Ketamine Treatment is Covered by Insurance?

Spravato® (Esketamine) – Yes

• FDA approval: Approved by the FDA in 2019
• Use: For treatment-resistant depression and major depressive disorder with suicidal ideation
• Insurance coverage: Often covered by insurance plans, Medicare, and Medicaid
• Providers: Must be administered under supervision at certified ketamine clinics or mental health facilities

Insurance companies that may cover Spravato® include:

• Aetna
• Blue Cross Blue Shield
• United Healthcare
• Others, depending on the state and policy

What Ketamine Treatment Is Usually Not Covered?

IV Ketamine and Other Off-Label Ketamine Infusions – Usually No

• Off-label use: IV ketamine is not FDA-approved for depression, anxiety, or PTSD
• Insurance companies often decline reimbursement for off-label ketamine infusion therapy
• Patients typically pay out-of-pocket for:
  • Initial evaluation
  • Infusions
  • Follow-up visits
  • Monitoring and psychotherapy

How Much Does Ketamine Therapy Cost Without Insurance?

Some ketamine clinics offer free consultations, payment plans, or accept credit cards and HSA/FSA payments.

Can You Get Reimbursed?

Possible with a Superbill

• Some clinics provide a superbill, an itemized receipt with medical codes
• You submit it to your insurance provider for possible reimbursement
• Approval depends on your:
  • Diagnosis
  • Coverage details
  • Use of in-network or out-of-network providers

Always check with your insurance plan in advance.

How to Check If Your Insurance Covers Ketamine Therapy

1. Call your insurance provider (ask about ketamine or Spravato coverage)
2. Confirm if your provider is in-network
3. Ask what’s required for pre-authorization
4. Review your plan’s co-pay, deductible, and out-of-pocket maximums
5. Speak with your healthcare provider or clinic’s billing coordinator

Side Effects and Supervision

While ketamine’s effects can be rapid and transformative, it may cause:

• Elevated blood pressure
• Dissociation
• Drowsiness
• Other side effects that require medical supervision

Only pursue ketamine therapy through licensed medical professionals.

Final Thoughts: Is Ketamine Therapy Covered by Insurance?

• Spravato® (esketamine nasal spray): ✅ Often covered
• IV ketamine infusions: ❌ Typically not covered, but reimbursement may be possible
• Always consult your insurance company, healthcare provider, or a certified ketamine clinic before starting treatment

Ketamine therapy can be a powerful option for severe depression and other mental health issues—but understanding your insurance coverage is essential for creating a sustainable treatment plan.

Published on: 2025-06-30
Updated on: 2025-06-30