Why setting matters more than people think
When patients first start exploring ketamine therapy, they often assume the safest option must be inside a hospital. The instinct is reasonable—hospitals are where the sickest people go, so hospitals must have the highest level of care. For ketamine, that intuition is incomplete. The right setting depends on the dose, the duration, the indication, and the patient’s overall medical picture. For most outpatient ketamine therapy, an office-based practice is the default standard of care, not a step down from a hospital.
Ketamine is FDA-approved as an anesthetic; its use for depression, PTSD, and chronic pain is off-label, delivered at sub-anesthetic doses much lower than what would be used in a surgical setting. That difference—sub-anesthetic versus anesthetic—is what makes office-based delivery appropriate for most patients. The major professional bodies that govern this work, including the American Association of Nurse Anesthesiology (AANA) and the American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP3), specifically endorse office-based outpatient delivery for the patient population most clinics see.
This is not a marketing claim. It is the consensus published in their standards documents. Setting matters, but not in the way most people initially assume.
What office-based anesthesia actually means under AANA standards
The AANA Standards for Office-Based Anesthesia Practice (2020) define what an office-based practice must do to deliver anesthesia care safely. These are not optional. They cover provider qualifications, monitoring, equipment, recovery, and emergency preparedness. When patients ask whether an office is “really set up for this,” this is the document that answers the question.
Under AANA standards, an office delivering anesthesia or sedation services must have:
- A qualified anesthesia provider in continuous attendance—a CRNA or anesthesiologist who oversees every infusion, with anesthesia-level monitoring throughout. Marla Peterson, CRNA, oversees every infusion at MCK.
- Continuous physiologic monitoring—pulse oximetry, blood pressure, heart rate, and EKG as appropriate, all documented during the session.
- Emergency equipment and medications on site, including oxygen, suction, an emergency airway kit, and reversal agents where applicable.
- Documented patient selection criteria—screening for cardiac, pulmonary, and psychiatric history before the first infusion is ever scheduled.
- Recovery and discharge protocols, including objective discharge criteria and a designated driver.
- Transfer agreements with a nearby hospital in the rare event a patient needs a higher level of care.
The ASKP3 Standards of Care for Ketamine Therapy (2024) layer on top of this by specifying what is appropriate for sub-anesthetic IV ketamine delivered for psychiatric indications: thorough screening, integration support, post-session monitoring, and clear escalation pathways for higher-acuity cases. ASKP3 specifically recommends office-based outpatient delivery for most psychiatric ketamine therapy and flags higher-acuity cases for higher levels of care.
What a hospital infusion looks like by contrast
A hospital-based ketamine infusion shares some elements with an office-based one—continuous monitoring, an anesthesia provider, emergency capability—but differs in several practical ways. Atmosphere is the most visible difference. A hospital infusion typically happens in a shared bay or treatment room, with bright lighting, overhead pages, and the rhythm of a busy clinical floor. For surgical recovery, that environment is fine. For ketamine therapy, where the experience itself is part of the work, it is often a poor match.
Equipment in a hospital is more extensive than what an office-based practice carries, but the additional equipment is usually not what sub-anesthetic patients need. Hospitals have crash carts, ICU beds, and the ability to escalate to mechanical ventilation. A patient receiving 0.5 mg/kg of IV ketamine over 40 minutes for depression is not going to need any of that, on average. The equipment exists for very different patient profiles.
Staffing is broader in a hospital and narrower in an office. A hospital infusion may involve a rotating cast of nurses, pharmacy technicians, residents, and consulting attendings. An office-based infusion is typically delivered by the same CRNA or anesthesiologist every time, who knows the patient’s history and titration response. For a treatment like ketamine, where consistency and rapport matter, the office model has clear advantages.
Cost is the most concrete difference. Hospital-based infusions are billed at facility rates, which include hospital overhead, technical fees, and often pharmacy markups. The same medication, delivered in an office, is far less expensive—though, as we discuss in our cost overview, neither setting is typically covered by insurance for off-label psychiatric use.
Indications that fit office-based: depression, anxiety, PTSD, most pain
For most candidates—treatment-resistant depression, anxiety, PTSD, OCD, and many chronic-pain conditions—office-based delivery is the appropriate setting. Doses are sub-anesthetic, sessions run 40 to 60 minutes, and patients are discharged home the same day with a driver. The data supporting this model is substantial.
The 2018 Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain, jointly published by ASRA, AAPM, and ASA (Cohen et al.), explicitly describe outpatient sub-anesthetic ketamine protocols for chronic pain, while reserving inpatient or hospital-based administration for specific patient profiles and protocols. The guideline framework assumes most outpatient pain infusions will be delivered in an office or ambulatory setting.
For psychiatric indications, ASKP3’s 2024 standards make a similar point: outpatient office-based delivery is appropriate for most depression, anxiety, and PTSD candidates after appropriate screening. The recommendation reflects what the published trials actually used. Most of the evidence supporting ketamine for these conditions comes from outpatient settings, not hospital wards.
Research suggests that the safety profile in office-based settings, when AANA standards are followed, is comparable to what is seen in hospital-based outpatient infusion clinics for the same indications. The dose is what determines risk far more than the building.
Indications that may need a hospital: complex cardiac, inpatient psych, multi-day CRPS
Hospital-based ketamine is the right answer for a smaller, well-defined group. The ASRA/AAPM/ASA chronic pain consensus and the ASKP3 psychiatric standards both flag specific scenarios where hospital delivery is preferred or required:
- Acute inpatient psychiatric care—particularly active suicidal ideation requiring inpatient observation, where the question of setting is downstream of the question of admission.
- Significant cardiovascular comorbidity—uncontrolled hypertension, recent cardiac events, or hemodynamically significant heart disease that warrants closer monitoring than an office can provide.
- Multi-day high-dose CRPS protocols—some CRPS regimens involve continuous infusion over several days at higher doses. These are typically delivered in a hospital or specialized inpatient pain unit.
- Pediatric or geriatric patients with complex medical histories, where the threshold for higher-level care is appropriately lower.
- Patients on medication regimens or with comorbidities that warrant a higher level of intra-procedural support.
None of this means hospital-based ketamine is “better.” It means it is the right tool for a particular subset of patients. For the majority of candidates seeking outpatient relief for depression, anxiety, PTSD, or chronic pain, the office setting is the standard, not a compromise.
Cost, access, and continuity differences
Beyond clinical fit, the practical differences between settings matter to the patient experience. Cost diverges sharply. Hospital-based facility billing includes overhead that an office practice does not carry. Insurance coverage is unpredictable in either setting for off-label use, but hospital-based bills, when partially covered, tend to come with much larger out-of-pocket residuals than office-based self-pay.
Access is also different. Hospital-based ketamine programs in Tennessee are typically accessed through pain medicine or psychiatry consultation at academic medical centers, often with multi-month wait times and referral hurdles. Office-based clinics tend to have shorter intake-to-first-infusion timelines, which matters when the patient is in active distress.
Continuity is where the office model arguably stands out the most. The same CRNA, the same room, the same recovery space, session after session. For a treatment where the experience itself contributes to the therapeutic outcome, this consistency is not cosmetic—it is part of the work.
Why MCK is office-based and how that shapes the experience
Music City Ketamine is an office-based outpatient practice operating under AANA office-based anesthesia standards. We chose this model deliberately because it fits the indication, the dose, and the patient population we serve. Sub-anesthetic IV ketamine for depression, anxiety, PTSD, and most chronic pain is short, low-dose, and same-day discharge. That is a textbook fit for office-based anesthesia care.
Marla Peterson, CRNA, oversees every infusion. She is a Certified Registered Nurse Anesthetist with the training and credentials required by AANA standards for office-based anesthesia practice. She handles screening, induction, monitoring, and recovery for every patient who walks through our doors. CRNA-led, anesthesia-level monitoring, on-site throughout—that is the operating model. Our safety overview describes the monitoring and protocols in detail.
The atmosphere is intentional. Private rooms, soft lighting, comfortable recliners, and our therapy dogs Walter White and Wilma. None of this is decoration—it is part of how we deliver care that meets the clinical standard while creating a setting that supports the experience itself. Most patients tell us this is what they did not know they needed.
Sessions are $475 each and include the consultation review, the infusion, monitoring, and recovery. We are transparent about pricing because, in this category, opacity does not serve patients well.
How to tell which setting is right for you
If you are deciding between office-based and hospital-based ketamine, a few questions help orient the choice. Are you medically stable, with no recent cardiac events, controlled blood pressure, and no active inpatient psychiatric concerns? Is your indication depression, anxiety, PTSD, OCD, or a chronic-pain condition that responds to standard outpatient sub-anesthetic protocols? Are you looking for same-day discharge, the same provider every time, and a calmer environment? If yes to most of these, an office-based practice that follows AANA and ASKP3 standards is almost certainly the right fit.
If your medical history is complex, if you are currently inpatient or near-inpatient acuity, or if your protocol calls for multi-day continuous infusion, a hospital-based program is the appropriate setting. We are happy to help patients sort that out at consultation. When someone is not the right fit for our practice, we tell them, and we point them toward the right level of care.
Talk to your prescribing provider about which setting fits your situation. Setting is not a badge of safety. The right setting is the one matched to your clinical picture, your indication, and the standards that govern that level of care.