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
Because ketamine infusions are administered off-label for depression, anxiety, and PTSD, most commercial insurers in New York have not included them in standard formularies.
That said, there are exceptions — especially for pain management indications and Spravato® (esketamine nasal spray), which carries FDA approval for treatment-resistant depression and is covered by many plans.
The quickest way to check is to call the member services number on the back of your insurance card and ask specifically about CPT codes 99213, 99214 (evaluation), and 94799 (infusion).
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.
A superbill is an itemized receipt that includes your diagnosis codes (ICD-10), procedure codes (CPT), provider NPI, and session details. You submit this directly to your insurer for potential out-of-network reimbursement. We provide superbills upon request — just ask at your appointment.
Most patients find ketamine surprisingly calming. You are monitored the entire time.