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

If you’ve read about the benefits of ketamine therapy and are ready to take the next step in determining how to pay for it, you’re probably wondering is ketamine therapy covered by insurance? The answer is complicated, but with the right info (and a few insider tricks), you can boost your chances of getting coverage, or find smart ways to afford treatment anyway.

If you’ve ever tried to figure out “is ketamine therapy covered by insurance?,” you already know it can feel like trying to solve a puzzle with half the pieces missing. And believe me—I get it. While I’ve never needed ketamine therapy myself, I have needed mental health treatment and had to tango with insurance rules that made zero sense. When I was searching for a certified EMDR therapist to help me work through trauma, I thought I was seeing someone in-network until I learned she was only covered for in-person sessions, not telehealth. Cue the surprise bill and a very confused (and frustrated) me. So yes, I know how hard it can be to find care that’s both accessible and affordable.

Whether you’re considering ketamine or esketamine (Spravato) adds another layer of complexity. Coverage varies wildly depending on whether the treatment is FDA-approved (like Spravato) or considered “off-label” (like intravenous, or IV, ketamine), plus how each insurer interprets medical necessity. Add in lingering stigma (most of us know ketamine only as a “party drug”), slow adoption of new treatments, and the ongoing parity gap in mental health coverage, and it’s no wonder patients, families, and even clinicians feel lost.

That’s where this guide comes in. We’ll break down what’s typically covered, what’s not, and how to check your own benefits without wanting to throw your insurance card across the room. And if you need help navigating the process, we’ll also show you how Radial supports patients every step of the way, so getting the right care doesn’t have to be its own full-time job.

Why insurance coverage for ketamine therapy is so complicated

Ketamine therapy has made major waves as a breakthrough option for treatment-resistant depression, often helping people who’ve tried everything else without relief. It’s also versatile: ketamine can be given intravenously (IV), intramuscularly, orally, or as a nasal spray.

So why isn’t it easier to access or covered by insurance? In short: red tape.

Ketamine-assisted therapy for mental health is considered “off-label,” says insurance expert Carlene MacMillan, MD, a dual board-certified child, adolescent, and adult psychiatrist and Radial’s chief product officer. Translation: while the FDA approved ketamine decades ago as an anesthetic, it hasn’t officially signed off on its use for depression, PTSD, or other mental health conditions. Because of that, insurers usually label it as “experimental” or “investigational” and won’t pay for it.

And then there’s esketamine, which sounds similar but isn’t identical. Ketamine is made up of two mirror-image molecules (R- and S-ketamine); esketamine only uses the S form. That small chemical tweak changes how the FDA regulates it.

Here’s where things get a little more hopeful: esketamine (brand name Spravato) is FDA-approved as a nasal spray for treatment-resistant depression, and for adults with major depressive disorder experiencing acute suicidal thoughts (when combined with an oral antidepressant). That approval means it’s far more likely to be covered by insurance.

Ironically, IV Ketamine is “potentially more cost-effective for a payer and for patients than on-label intranasal esketamine,” but “payers are very reluctant to make standing coverage policies to cover off-label treatments,” says Dr. MacMillan.

Confused yet? You’re not alone. Let’s break down the jargon:

• FDA-approved: The FDA has reviewed the evidence and deemed the medication safe and effective for a specific condition.
• Off-label use: A drug that’s FDA-approved for one condition but prescribed for another. This practice is common, legal, and ethical as long as it’s supported by solid data and clinical judgment.
• Experimental (or investigational): A drug still being tested in humans under FDA oversight. It’s not yet available for sale or prescription.

What treatments insurance covers—and what it doesn’t

In general, insurers are far more generous with medications that have the FDA’s official stamp of approval. That’s why ketamine infusions—an off-label treatment—are usually an out-of-pocket expense, while Spravato (the FDA-approved esketamine nasal spray) has a much better shot at being covered.

But here’s the twist: FDA approval doesn’t automatically equal easy access. Regulators like the FDA decide whether something is safe and effective. Insurers decide whether it’s “reasonable and necessary,” and that determines coverage. Those two decisions don’t always line up, and patients are often impacted.

Below is where things stand now.

Are IV ketamine infusions covered by insurance?

Because IV ketamine isn’t FDA-approved for mental health conditions, insurers typically label it “experimental” or “investigational.” Sadly, even if it changes someone’s life, insurance usually won’t foot the bill.

A few payers are starting to break rank, though. Blue Cross Blue Shield (BCBS) of Massachusetts has a pioneering policy that “covers IV ketamine for depression using similar criteria as their esketamine policy,” says Dr. Macmillan. “Several other local payers in Massachusetts have followed their lead,” she says. Kaiser Permanente in the San Francisco bay area also offers some coverage. 

But nationally? Insurance covered ketamine infusions are still the exception, and Medicare and Medicaid don’t cover IV ketamine at all.

Still, case-by-case exceptions do happen, says Dr. MacMillan. For example, if you’re working with an out-of-network clinic, you can pay upfront and submit a superbill (an itemized receipt of services you received) to your insurer. Oddly enough, this sometimes yields better reimbursement than staying in-network because out-of-network claims aren’t always scrutinized as heavily, she explains.

Is ketamine-assisted psychotherapy covered by insurance?

While insurers typically won’t cover ketamine infusion therapy itself, here’s the silver lining: they may cover the surrounding services. Some clinics bill the initial consult, labs, and follow-up visits to insurance.

Psychotherapy sessions are often covered too as long as they’re documented as medically-necessary and meet therapeutic standards, says Dr. MacMillan. Preparation and integration sessions usually qualify if your provider is in-network, she says.

Therapy during the actual ketamine dosing session may or may not be covered, depending on what’s happening clinically. Documentation needs to show what was “therapeutic” versus a clinician simply “holding space,” explains Dr. MacMillan.

If your clinician is out-of-network, you can also submit a superbill for reimbursement. How much you get back varies widely. Patients “can expect to get anywhere from 20–50% back, depending on deductibles, usual and customary rates for the geographic area, and out-of-pocket maximums,” says Dr. MacMillan. But don’t count your “chickens before they hatch,” she warns: Until the claim is processed and you have the check in hand, you really don’t know. Her advice: “Hope for the best, but be prepared for the worst.”

The takeaway: coverage is unpredictable. Your safest move is calling your insurer ahead of time to confirm your deductible, benefits, and whether you get reimbursed per session or as a percentage. 

Is Spravato (esketamine) nasal spray covered by insurance?

“Most major commercial and government payers cover Spravato,” says Dr. MacMillan. If the clinic is in-network, you usually just owe a standard office-visit copay—often $30–$50, she says.

But like all things insurance, there are hoops. Most plans require patients to meet specific criteria before approving esketamine coverage. Here are examples from UnitedHealthcare:

For treatment-resistant major depressive disorder:

1. A formal MDD diagnosis (per DSM-5-TR) by a mental health professional
2. Documentation of baseline depression scores before starting treatment
3. Proof of trying—and not responding to—at least two antidepressants for 8 weeks each
4. Treatment in a clinic certified in the Spravato Risk Evaluation and Mitigation (REMS) program (which ensures safe monitoring because of risks like sedation and dissociation)
5. Prescription or consultation by a psychiatrist

For MDD with acute suicidal ideation or behavior:

1. Confirmed MDD diagnosis
2. Active suicidal ideation or behavior
3. Spravato used alongside a newly started or optimized oral antidepressant
4. Treatment in a REMS-certified setting

How much does ketamine therapy cost?

Sticker shock incoming: Ketamine treatment costs are all over the map, depending on the type of treatment you choose (IV infusion, psychotherapy, Spravato, etc.), the kind of insurance you have, and where you live. Let’s take it piece by piece.

Though it varies, most practices charge anywhere from $400 to $800 per IV ketamine infusion, says Dr. MacMillan. The out-of-pocket cost usually includes the medication and the infusion itself, and an initial course typically involves 6–8 sessions—so yes, “we are looking at several thousand dollars,” she says.

If therapy is part of the process, which is not always the case, that’s often billed separately. Therapy sessions can run in the same cost range of $400 to $800. Because this is highly specialized work, many therapists don’t take insurance and charge higher private rates, explains Dr. MacMillan. Some clinics bundle therapy into a program, but pricing varies, she adds.

The actual ketamine in a single infusion costs a clinic under $10, says Dr. MacMillan. What you’re really paying for is the monitoring, staff, time, equipment, safety protocols, and the specialized environment required for treatment, she says.

Location adds another layer of complexity. Practices in high-cost-of-living areas usually charge more than those in less affluent regions (think big coastal cities vs. smaller metros or rural areas), says Dr. MacMillan.

Some good news: Spravato (esketamine nasal spray) is usually much easier on your wallet. “Most major commercial and government insurers cover Spravato,” says Dr. MacMillan. If your clinic is in-network, you typically just pay your usual office-visit copay (often $30–$50). Fun fact: in states where IV ketamine is covered by some plans (like BCBS of Massachusetts), those infusions can cost the same low copay too, she adds.

If your clinician is out-of-network, you can submit a superbill and might get 20–50% reimbursed depending on your plan’s deductible, “usual and customary” rates, and out-of-pocket max, says Dr. MacMillan. But, once again, don’t count on a windfall—coverage for ketamine-related care can be hit-or-miss, and sometimes you’re still footing most of the bill.

How to check your insurance coverage 

Before you dive into ketamine treatment, you’ll want to know what your insurance actually covers—because surprises are great for birthdays, not medical bills. Here’s how to get the clearest picture of your costs, according to Dr. MacMillan.

Start with a quick search

First stop: the internet (obviously). You can google your insurance provider’s name plus terms like “ketamine policy” or “Spravato insurance coverage.” These documents are usually public, says Dr. MacMillan. You can even ask ChatGPT, as long as it links back to the insurer’s official site, she adds.

Contact your insurance company

Next up: calling the number on the back of your insurance card—"everyone’s favorite pastime,” as Dr. MacMillan jokes. When you’re on the line, ask about:

• Whether the specific procedure you need is covered
• Your copay, deductible, and coinsurance
• Any required prior authorizations
• Whether your provider is in-network
• Your out-of-network benefits—and how much your plan reimburses for the relevant procedure codes (these are the special codes that correspond to the services you receive—you can get these from your provider or clinic)

Work with the clinic’s financial coordinator

And finally: use the experts at the clinic itself. Most ketamine practices have financial coordinators who deal with these policies every day. And if they’re in-network for ketamine or Spravato, they’ll know the coverage criteria like the back of their hand—things like required prior medication trials, current medications, symptom severity, and any documentation your insurer wants, says Dr. MacMillan.

What to do if your insurance doesn’t cover ketamine or esketamine

If your insurer says “nope,” don’t panic—you’ve still got options. Here’s how to push back, get creative, and maybe even save some cash along the way.

Try an appeal

Think of an insurance denial as a “not yet,” not a hard stop. You can appeal, especially in “complex cases where nothing else has worked” and ketamine has clearly helped prevent higher-level (and more expensive) care, says Dr. MacMillan. 

Appeals usually involve submitting documentation that shows why ketamine is “medically necessary” (here’s a sample template for a letter of medical necessity). Teaming up with a psychiatrist who knows how to navigate the appeals system can make a huge difference.

Loop in your HR department

If your insurance comes through work, HR might be your secret weapon. Employers with self-funded plans have “more leeway on what they can approve,” says Dr. MacMillan. Some companies—like Enthea and First Tracks—offer add-on benefits that cover ketamine for self-funded employers. You can advocate for leadership to include ketamine coverage during annual enrollment, she says.

Use your FSA or HSA to your advantage

If insurance won’t help, your pre-tax dollars can. Flexible spending accounts (FSAs) and health savings accounts (HSAs) let you set aside money for eligible medical expenses, and ketamine treatment often qualifies. It’s a smart backup plan if coverage or reimbursement isn’t guaranteed. 

Check for veteran and first-responder benefits

If you’ve served—or serve—your community, you may qualify for extra support. Some VA systems cover IV ketamine and esketamine treatments, and many clinics offer discounted rates for veterans, first responders, active-duty service members, and healthcare workers, says Dr. MacMillan. Check individual clinic websites for details.

See if you qualify for Spravato withMe

If you’re prescribed Spravato for an approved use, this savings program can be a game changer. Eligible adults can access the Spravato withMe program for free, and those with commercial insurance may pay as little as $10 per treatment. Care navigators can also help you explore financial assistance programs even if you’re uninsured.

Consider switching plans

If your insurance won’t budge, another plan might. When buying insurance through the marketplace, you can switch during the next enrollment window to a plan that covers ketamine or esketamine if one exists in your area, says Dr. MacMillan.

Advocate for broader change

Sometimes the fix isn’t individual—it’s systemic. “If you have a Medicaid plan, lobbying at the state level may help [influence policy] and has led to some success in some states like MA,” says Dr. MacMillan. “In addition, you can always contact the Ketamine Task Force to see what efforts may be underway to expand coverage.” 

How Radial helps patients navigate insurance and access care

Getting care shouldn’t feel like decrypting a secret code, and Radial is here to simplify the whole thing. Their team knows insurance for ketamine and esketamine can get confusing fast, so they work with you to find affordable paths forward and make treatment accessible to as many people as possible.

Radial partners with most major insurance plans, and they’re constantly pushing for broader coverage, including advocating for payer policy changes that support emerging, evidence-based treatments. You can check out their current list of accepted plans, and if yours isn’t on it, reach out. Coverage is always expanding, and your plan may have been added recently.

When insurance can’t (or won’t) help, Radial still offers options. Through a partnership with Living Water—a registered 501(c)(3)—they offer a financial hardship program that can significantly reduce costs for certain treatments based on income. They also accept HSA/FSA cards, work with financing partners like CareCredit and Wisetack for “buy-now-pay-later” plans, and can set up flexible payment arrangements when needed.

And if navigating benefits makes your eyes glaze over, Radial’s got you. A care navigator will walk you through your coverage, verify your benefits, break down expected out-of-pocket costs, and connect you with a clinician to help you decide if treatment is the right fit.

The bottom line

Understanding ketamine therapy insurance coverage can feel a lot like navigating a maze. But once you know what insurers typically cover and what they don’t, you can map out your best path forward. And if your plan says no, you’re not out of options: appeals, HR advocacy, savings accounts, financial-aid programs, and even switching plans can all make treatment more accessible.

When you’re ready to take the next step, Radial can help you cut through the red tape. They’ll connect you with licensed clinicians—virtually or in person—who actually listen, who understand your needs, and who can craft a treatment plan that fits your life. We’ll help you navigate insurance so you don’t have to do it alone.

Key takeaways

• Insurance coverage for ketamine varies widely—Spravato (esketamine) is often covered, while IV ketamine usually isn’t.
• Most insurers require strict criteria for Spravato approval, including trying at least two antidepressants first.
• If you’re denied coverage, you can appeal, ask HR about self-funded plan options, or switch to a plan that does cover ketamine.
• FSAs/HSAs, discount programs, financial-hardship support, and manufacturer savings programs can all lower out-of-pocket costs.
• It’s useful to find a clinic that accepts many insurance plans, offers financial-assistance options, and helps patients navigate coverage from start to finish.

Frequently asked questions (FAQs) 

Does Blue Cross Blue Shield cover ketamine treatment?

Short answer: sometimes. Coverage depends on your specific plan. For instance, Blue Cross Blue Shield of Massachusetts (an "independent licensee" of the larger Blue Cross and Blue Shield Association) covers IV ketamine and Spravato when certain medical-necessity criteria are met. Most other major insurers, though, still don’t cover ketamine infusions. To know for sure, call your plan to ask about in-network coverage and any out-of-network benefits.

Is ketamine treatment covered by Medicaid?

In most states, Medicaid does not cover IV ketamine for mental health conditions because it’s considered an off-label use. One analysis, for example, found that no Medicaid plans in Ohio covered IV ketamine for depression. However, Medicaid may cover Spravato (esketamine)—the FDA-approved nasal-spray version—if you meet criteria for treatment-resistant depression. Some states, like New York, already cover it.

How do I know if I’m eligible for Spravato coverage?

“Most major commercial and government payers cover Spravato,” says Dr. MacMillan. But there’s usually some fine print. Many plans require documentation showing you’ve tried—and didn’t improve on—at least two antidepressants, and treatment must be done in a clinic certified through the Spravato REMS program. Checking with your insurer (or having your clinic do it for you) is the quickest way to confirm.