Does Insurance Cover Ketamine Therapy for Mental Health Treatment?

Insurance coverage for ketamine as a mental health treatment is limited and depends heavily on which form of ketamine you’re receiving and what insurance plan you have. Most insurance companies are reluctant to cover ketamine treatments, particularly because many applications haven’t received full FDA approval for psychiatric use.

Your best chance of getting mental health insurance coverage in Los Angeles is with Spravato®. Many insurers will consider covering Spravato® if you meet certain requirements, though you’ll need to obtain prior authorization first. For those on Medicare, approximately 80% of Spravato costs are covered once you’ve met your annual deductible, leaving you responsible for the remaining 20%. Major private insurance companies, such as Blue Cross Blue Shield, UnitedHealthcare, and Cigna, may also provide coverage. Still, they typically require proof that you’ve already tried and not responded to several other antidepressants.

Standard ketamine infusions through IV or intramuscular injection face significant coverage challenges. Medicare doesn’t cover IV ketamine for psychiatric purposes at all. There are some limited exceptions: veterans may receive coverage for PTSD treatment through the VA, and occasionally, certain Blue Cross Blue Shield plans may offer partial reimbursement in specific situations.

The best approach is to call your insurance company directly before starting treatment. Ask specifically about their policies on both IV ketamine and Spravato®, find out what documentation they need for prior authorization, and confirm whether your preferred provider participates in your insurance network. Your psychiatrist or treatment provider can also assist with the paperwork to improve your odds of getting coverage approved.

What Types of Ketamine Therapy Are Eligible for Insurance Coverage?

While insurance coverage for ketamine therapy remains limited, certain FDA-approved forms and specific medical contexts have a better chance of reimbursement than others. Here are the types of eligible ketamine therapy insurance coverage:

• Spravato®: This is the most widely covered form of ketamine therapy for mental health treatment. Since receiving FDA approval in 2019 for treatment-resistant depression and later for major depressive disorder with acute suicidal ideation, many insurance plans, including Medicare, Medicaid in some states, and major private insurers, now cover Spravato®. Coverage typically includes both the medication itself and the mandatory monitoring sessions, though prior authorization is almost always required.
• Ketamine as Anesthesia in Medical Settings: When ketamine is used for its original FDA-approved purpose as an anesthetic during surgical procedures or emergency medicine, insurance companies routinely provide full coverage. This applies to hospital settings, surgical centers, and emergency departments where ketamine serves as a sedative or pain management tool rather than a psychiatric treatment.
• Ketamine for Chronic Pain Management – Some insurance plans may cover ketamine infusions when prescribed specifically for certain chronic pain conditions, particularly Complex Regional Pain Syndrome (CRPS) or neuropathic pain that hasn’t responded to other treatments.
• VA Coverage for Veterans with PTSD – Veterans receiving care through the Department of Veterans Affairs may have access to ketamine therapy for post-traumatic stress disorder, particularly when traditional treatments have proven ineffective.