Does Medicare Cover Ketamine Therapy?

Short answer: Medicare does cover Spravato, the FDA-approved esketamine nasal spray, for treatment-resistant depression. It does not cover IV ketamine infusions for mental health, because that use is off-label. The distinction is regulatory rather than clinical. Here is how the coverage actually works and what your options are either way.

IV ketamine: not covered

Medicare does not cover IV, intramuscular, or oral ketamine for depression or other psychiatric conditions. The reason is not that Medicare doubts it works. It is that ketamine is FDA-approved as an anesthetic, so using it for depression is considered off-label, and Medicare does not cover off-label psychiatric ketamine. That rule applies regardless of how well the treatment might help you.

Spravato: covered

Spravato is the exception, and an important one. Because esketamine is FDA-approved specifically for treatment-resistant depression, Medicare covers it. Coverage generally falls under Part B when the medication is administered in a certified medical facility, and Part B typically pays 80 percent of the approved cost after you meet your annual deductible. Depending on how it is administered, Part D can also come into play. The mandatory post-dose observation period is usually included in the covered service.

What you need to qualify

Coverage for esketamine typically requires that you have already tried at least two adequate courses of oral antidepressants without enough relief. Treatment also has to happen in a certified setting with monitoring afterward. Your provider can confirm whether you meet the criteria and handle the paperwork.

How to check your specific plan

Medicare Advantage plans can differ from Original Medicare, so it is worth calling the number on your card and asking directly: Is Spravato covered for depression under my plan? Is it billed under Part B or Part D? What is my share of the cost, and what are the prior authorization requirements? Our guides to whether insurance covers ketamine and Medicaid coverage walk through similar questions.

If IV ketamine is the right fit but is not covered

Many people choose IV ketamine even without coverage, because for them it works when other treatments have not. At Ketamine Uplift, we built our own in-house financing so cost is less of a barrier. The standard eight-infusion course is $3,999, and you can pay $3,399 upfront, choose a Split-Pay plan of $1,000 down then $237 a month, or a Flexible plan of $333 a month for twelve months at zero percent interest. If affordability is a concern, it is always worth a conversation.

Spravato is coming soon to Ketamine Uplift

For Medicare patients especially, this matters: Spravato is coming soon to Ketamine Uplift. Because Medicare covers Spravato for treatment-resistant depression, it will give more of our patients a path that may be substantially covered. If that is relevant to you, reach out and we can talk through the timing.

This article is for educational purposes only and is not medical or financial advice. Coverage rules and costs change; confirm current details directly with Medicare or your plan.

The bottom line

Medicare covers Spravato for treatment-resistant depression, usually under Part B in a certified setting, but it does not cover off-label IV ketamine infusions. If IV ketamine is what you need, financing can make it manageable, and if coverage matters most, Spravato is the route to discuss. Questions about coverage or cost? Call us at (310) 280-4440.

Frequently asked questions

Does Medicare cover ketamine infusions?
No. Medicare does not cover IV, IM, or oral ketamine for mental health because that use is off-label. Ketamine is FDA-approved as an anesthetic, and Medicare does not cover off-label psychiatric use.

Does Medicare cover Spravato?
Yes, for treatment-resistant depression. It is typically covered under Part B when given in a certified facility, with Part B generally paying 80 percent of the approved cost after your annual deductible.

What do I have to do to qualify for Spravato under Medicare?
Coverage typically applies after you have not responded to at least two adequate trials of oral antidepressants, with treatment given in a certified setting.

What if Medicare will not cover IV ketamine for me?
You still have options, including in-house financing to spread the cost over time. Spravato, which Medicare does cover, may also be worth discussing.