Does Insurance Cover Ketamine Therapy?
What You Need to Know About Ketamine & Insurance
IV Ketamine is largely out-of-network
Most major insurers do not directly reimburse for IV ketamine infusions for mental health. However, out-of-network benefit submissions are possible with the right documentation.
HSA & FSA funds can be used for ketamine infusions
If you have a Health Savings Account or Flexible Spending Account, you can typically use those pre-tax dollars for ketamine infusions as a qualified medical expense.
We provide superbills for reimbursement
Ketamine Wellness NY provides itemized superbills with all necessary procedure and diagnosis codes, giving you the best chance at partial reimbursement from your insurer.
Understanding How Coverage Works
IV ketamine is used off-label for depression, anxiety, PTSD, OCD, and chronic pain. Coverage rules differ by carrier and by treatment type. Below is a 2026 snapshot for the largest insurers serving New York patients. Ketamine Wellness NY administers IV ketamine only. The Spravato coverage details below are provided so you can make an informed choice about your treatment options.
Aetna
Aetna Clinical Policy Bulletin #0938 classifies IV ketamine for psychiatric use as experimental. CPB #0950 covers Spravato for treatment-resistant depression with documented failure of two antidepressant classes. HMO, PPO, and POS plans differ in out-of-network flexibility. See our Aetna coverage guide for plan-specific details.
UnitedHealthcare and Cigna
Empire BlueCross BlueShield
NYRx Medicaid
NYRx Medicaid covers Spravato with prior authorization for patients meeting TRD criteria. IV ketamine is not covered in 2026. This applies across Fidelis, Healthfirst, MetroPlus, EmblemHealth, UnitedHealthcare Community Plan, and Molina. See our NY Medicaid coverage guide for full detail.
Medicare
How to Verify Your Insurance Benefits Before Booking
Ask these five questions:
Do I have out-of-network mental health coverage? If yes, what percentage of the allowed amount does my plan reimburse?
What is my current out-of-network deductible? How much have I already met this year?
What is my reimbursement rate for CPT code 99215 with modifier 25? (Established patient office visit, billed with each infusion.)
What is my reimbursement rate for CPT code 96365? (Intravenous infusion procedure code, first hour.)
What is my reimbursement rate for CPT code 99203? (New patient initial evaluation, billed only at your first visit.)
Write down the confirmation number and the name of the representative you spoke with. Some plans quote reimbursement rates that turn out to be different at claim time. A documented call is your record if you need to dispute a discrepancy later.
Ketamine Wellness NY is a cash-pay clinic. Payment is due at the time of service. To help you pursue out-of-network reimbursement from your insurer, we provide a detailed superbill at the end of each session. The superbill includes the date of service, the diagnosis codes (ICD-10) our clinical team documented, the procedure codes (CPT 99215 with modifier 25 for the office visit, 96365 for the IV infusion, and 99203 for your initial evaluation when applicable), and Dr. Pervaiz Qureshi's provider NPI. You submit the superbill directly to your insurer as an out-of-network claim. Based on patient reports at our clinic, roughly 20 to 50 percent of session cost is commonly reimbursed depending on your out-of-network mental health benefit. Reimbursement outcomes vary by plan.
What to Do If Your Insurance Denies Ketamine Coverage
Peer-to-peer review
Peer-to-peer review is the fastest first step. Your treating physician requests a scheduled phone call with the insurer's medical reviewer to discuss the case. This route often resolves documentation-gap denials without requiring a full appeal cycle.
Internal appeal
An internal appeal is a formal written appeal filed with the insurer. It requires a Letter of Medical Necessity from your treating physician, addressing the insurer's stated denial reason directly. Internal appeals for pending services are typically decided within 30 days.
External appeal (NY DFS)
If internal appeals fail, eligible New York patients can request an external appeal through the New York Department of Financial Services. An independent reviewer evaluates the case, and the decision is binding on both patient and insurer. Standard appeals within 30 days. Expedited within 72 hours.
Ketamine Wellness NY does not handle insurance appeals. If you have been denied coverage for Spravato, the REMS-certified clinic that submitted your prior authorization is your best appeal partner. For a full walkthrough of appeal options and NY-specific rights, see our insurance denial appeal guide.
What’s Typically Covered vs. Not Covered
Coverage varies by plan, but here’s a general guide.
Often partially covered
- Initial psychiatric consultation (CPT 99213/99214)
- Spravato® (esketamine) — FDA-approved, covered by many plans
- Follow-up medical management visits
- Out-of-network reimbursement (plan dependent)
Typically Not Covered
- IV ketamine infusions for psychiatric indications
- Integration therapy sessions (unless billed separately)
- Booster/maintenance infusions
Flexible Ways to Pay for Treatment
We believe cost should not be a barrier to care. Ketamine Wellness NY offers several options to help you access the treatment you need.
HSA / FSA
Use pre-tax health savings dollars to cover the full cost of your infusions and consultations.
Superbill & Reimbursement
We provide detailed receipts for out-of-network submission. Based on patient experience at our clinic, many recover 20–50% of the session costs.
Package Pricing
Save $150 with our 6-session package at $3,150 — the most effective protocol at the lowest per-session rate.
HSA / FSA
Use pre-tax health savings dollars to cover the full cost of your infusions and consultations.
Superbill & Reimbursement
We provide detailed receipts for out-of-network submission. Based on patient experience at our clinic, many recover 20–50% of the session costs.
Package Pricing
Save $150 with our 6-session package at $3,150 — the most effective protocol at the lowest per-session rate.
Frequently Asked Questions
Does insurance cover ketamine therapy for depression in New York?
Standard commercial insurance rarely covers IV ketamine for psychiatric indications due to its off-label status. However, some patients successfully pursue out-of-network reimbursement by submitting documentation of a treatment-resistant diagnosis, and our team can help you prepare that.
Is Spravato® (esketamine nasal spray) different from IV ketamine for insurance purposes?
Yes. Spravato® has received FDA approval specifically for treatment-resistant depression and is covered by many major plans, including Aetna, UnitedHealthcare, Cigna, Medicaid, and Medicare. Ask us whether you may be a candidate.
Can I use my HSA or FSA card directly with Ketamine Wellness NY?
Yes, in most cases. Ketamine infusions are widely regarded as a qualified medical expense under IRS guidelines. We accept HSA and FSA cards as a form of payment. We recommend confirming eligibility with your card administrator beforehand.
Does Ketamine Wellness NY provide a superbill?
Yes. Ketamine Wellness NY provides a detailed superbill at the end of each session. The superbill includes your diagnosis codes (ICD-10), procedure codes (CPT 99215 with modifier 25 for the office visit, 96365 for the IV infusion procedure, and 99203 for your initial evaluation when applicable), the date of service, and Dr. Pervaiz Qureshi’s provider NPI, formatted so you can submit it directly to your insurer as an out-of-network mental health claim. We do not submit claims on your behalf, and we do not guarantee reimbursement, but the documentation you receive is complete. Based on patient reports at our clinic, roughly 20 to 50 percent of session cost is commonly reimbursed depending on your out-of-network mental health benefit.