Will my insurance cover any of this?

For IV ketamine used to treat depression, anxiety, PTSD, or chronic pain, the honest answer is usually no. Those uses are off-label, and most plans treat off-label IV ketamine as not medically necessary or not a covered benefit. Out-of-network reimbursement through a superbill is sometimes possible but unpredictable. Spravato (esketamine) nasal spray is the exception — it is FDA-approved for treatment-resistant depression and is sometimes covered under medical or pharmacy benefits.

Why don't you fight insurance for me?

It's your plan, you're the policyholder, and the appeal path runs between you and your insurer. We are not in your insurance network and have no contract with your plan, so we have no leverage to negotiate coverage on your behalf. What we can do is give you a complete superbill with diagnosis codes, procedure codes, dates of service, and provider credentials so you have everything you need to submit your own claim if you choose.

What does HSA or FSA cover at MCK?

HSA and FSA accounts can generally be used for qualified medical expenses for the diagnosis or treatment of a medical condition, which includes off-label IV ketamine when prescribed by a qualified clinician. Many MCK patients pay with their HSA or FSA card directly, or reimburse themselves later with our receipt. We cover the details in our HSA and FSA guide.

What if I genuinely can't afford the protocol?

Tell us. We would rather have an honest conversation about cost than have you start a protocol you can't finish. Our standard rate is $475 per session, and our cost article walks through what is included. Some patients space sessions out, use HSA or FSA funds, or combine ketamine with other elements of their care plan. We won't pretend to offer hardship pricing we don't have, but we will be straight with you about what is realistic.

Why We Don't Take Insurance for Ketamine — And What We Do Instead

Q: Is there any way to get partial reimbursement?

Sometimes, yes. If your plan offers out-of-network mental health benefits, you can submit our superbill as an out-of-network claim. Some patients receive partial reimbursement after meeting their out-of-network deductible; others receive nothing. Outcomes depend entirely on your specific plan, so we cannot promise a result.

The short version: ketamine for depression is off-label

The first thing to understand about insurance and ketamine is the regulatory framing. Ketamine itself was approved by the U.S. Food and Drug Administration in 1970 as a general anesthetic. That is the only indication on its label. Every other use of generic IV ketamine in modern medicine—for treatment-resistant depression, anxiety, PTSD, OCD, complex regional pain syndrome, fibromyalgia, neuropathic pain, and so on—is what physicians call off-label.

Off-label prescribing is legal, common, and often grounded in strong clinical evidence. It is also the single biggest reason most commercial insurance plans, Medicare, and Medicaid generally do not cover IV ketamine for these conditions. Payers tend to draw a hard line between FDA-approved indications and everything else, and that line determines what they will and will not pay for. The 2023 FDA Drug Safety Communication on compounded ketamine for psychiatric disorders states the agency's position plainly: ketamine is not FDA-approved for any psychiatric disorder, and patients should be aware that off-label use is not the same as approved use.

What “off-label” actually means and why payers won't cover it

When a drug is FDA-approved, the approval is for a specific indication, dose, route, and patient population. Insurers build their coverage policies around those approved uses. The Centers for Medicare and Medicaid Services (CMS) sets the broad framework most commercial payers follow, and CMS coverage policy generally requires a treatment to be considered “reasonable and necessary” for the diagnosis being treated. For drugs, payers commonly read that as “FDA-approved for this indication, or supported by recognized compendia.”

Off-label IV ketamine for depression, anxiety, or pain rarely meets that bar in the eyes of a claims adjudicator, even when the clinical literature supports it. The result is predictable: claims get denied as “not medically necessary” or “not a covered benefit,” appeals succeed only occasionally, and providers who try to bill insurance for off-label IV ketamine often find themselves in a long, losing fight with intermittent partial wins.

Worse, some clinics quietly bill insurance for the infusion procedure code or the office visit, and then surprise the patient with a balance bill for the difference between what the insurer paid and what the clinic charges. That is not a model we are willing to operate.

What Spravato (esketamine) coverage does and doesn't tell you

There is one important exception that often confuses patients shopping around. Spravato, brand name for esketamine nasal spray, is FDA-approved. The FDA approved Spravato in 2019 for treatment-resistant depression in adults when used together with an oral antidepressant, and later for major depressive disorder with acute suicidal ideation or behavior. Because Spravato is on-label for those indications, many commercial plans and Medicare will cover it under a medical or pharmacy benefit, often with prior authorization.

That coverage does not extend to IV ketamine. Spravato and IV ketamine are pharmacologically related but legally and commercially distinct. Spravato is a single-enantiomer nasal spray with its own FDA dossier; IV ketamine is the racemic generic anesthetic used off-label. If you call your insurer and ask “do you cover ketamine,” the answer they give you may be about Spravato. We cover the differences in detail in our ketamine versus Spravato comparison.

Spravato is a legitimate option for some patients, and we won't talk you out of it if your plan covers it and your prescriber recommends it. We just want you to understand which product your insurer is actually pricing.

Why we don't bill insurance even when we could try

We could, in theory, submit claims to commercial insurers using procedure codes for IV infusion, office visit, and monitoring. Some clinics do this. The reasons we don't are practical and ethical.

The denials are predictable. Off-label IV ketamine for psychiatric or pain indications is routinely denied. Building a business around fighting denials forces clinics to either over-bill, up-code, or pass appeal costs back to patients. None of that aligns with how we want to practice.
Network contracts compromise care. In-network reimbursement rates are often well below the cost of running a CRNA-led infusion program with anesthesia-level monitoring. Clinics that take in-network rates tend to compensate by shortening sessions, skipping monitoring, or pushing higher patient volume. We would rather opt out and keep the clinical standard.
Transparent self-pay is honest. The American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP3) Standards of Care recommend transparent disclosure of cost, the off-label nature of treatment, and out-of-pocket expectations as part of informed consent. We follow that standard. You know the price before you book, and the price doesn't change.

Ketamine is FDA-approved as an anesthetic; its use for depression, anxiety, PTSD, and chronic pain is off-label. We say that on our intake forms, on the phone, and in writing. It is the same disclosure your prescribing clinician should give you before any off-label prescription.

The superbill option — how it works and what it covers

Even though we don't bill insurance directly, you may still be able to recover part of what you pay. The mechanism is called a superbill. A superbill is an itemized receipt that includes the diagnosis code (ICD-10), the procedure codes (CPT) for what was done, the date of service, our practice's tax ID and credentials, and the amount you paid. It is the same documentation a clinic would submit on your behalf if it were in your network — you just submit it yourself, as an out-of-network claim.

Whether you get reimbursed and how much depends on your plan. Some plans have meaningful out-of-network mental health benefits with their own deductible and coinsurance. Others have functionally none. Some patients receive partial reimbursement after meeting the out-of-network deductible; others receive zero. We can't promise an outcome because we don't control the plan. What we can do is hand you a clean, accurate superbill and walk you through the submission process.

We do not promise coverage, we do not estimate reimbursement amounts, and we do not advertise “insurance accepted.” Treat any superbill reimbursement as a possible bonus, not a planned offset.

HSA and FSA: eligible, and why

The other practical lever is your tax-advantaged health spending account. Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) allow pre-tax dollars to be used for qualified medical expenses, and IRS Publication 502 defines those broadly as expenses for the diagnosis, cure, mitigation, treatment, or prevention of disease. Off-label IV ketamine prescribed by a qualified clinician for a diagnosed condition generally qualifies.

Many MCK patients pay with their HSA or FSA debit card directly at checkout. Others pay with another card and reimburse themselves later using the receipt and superbill we provide. We get into the documentation specifics in our HSA and FSA guide for ketamine, including what to do if your administrator flags the charge for substantiation. Used well, HSA and FSA dollars can effectively reduce the cost of a protocol by your marginal tax rate.

What you actually pay at MCK and what's included

Our standard rate is $475 per session. That covers the full clinical visit: medical consultation, vitals and pre-session assessment, the IV ketamine infusion itself, continuous anesthesia-level monitoring by Marla Peterson, CRNA, the post-session recovery period, and our follow-up communication. There is no separate facility fee, no surprise add-on for monitoring, and no “membership” required to access the price.

Initial protocols vary by indication. A typical psychiatric induction series is six sessions over two to three weeks, followed by booster sessions as clinically indicated. Pain protocols may differ in dose and cadence. We map the expected total cost during your consultation so you can plan, and we don't move forward until you understand the full number.

What to ask your insurer before you assume the answer

Before you assume your plan won't help at all, it can be worth a short call to member services. A few specific questions tend to produce more useful answers than a generic “do you cover ketamine.”

Do I have out-of-network mental health benefits? If so, what is my out-of-network deductible and coinsurance?
Will you accept a superbill submission for an out-of-network claim with diagnosis code F33.2 or F41.1 (or whatever applies to you)?
Do you cover Spravato (esketamine) nasal spray for treatment-resistant depression, and what is required for prior authorization?
For chronic pain protocols, do you cover any in-office IV infusion procedure codes for pain management performed by a CRNA?
Is my HSA or FSA debit card configured to allow medical office charges?

Whatever the answers, our position does not change: we are self-pay, the price is the price, and the documentation we give you is honest. If a plan happens to reimburse you something on the back end, that is upside. If it doesn't, you still know exactly what you paid for and why. For the broader picture of how we operate clinically, our how it works page and the about page lay out the structure of a typical patient journey.

Ketamine therapy is a real clinical intervention with real costs and real benefits. The honest framing is that the coverage system has not caught up to the off-label evidence base, and pretending otherwise would not serve you. We would rather tell you the truth about insurance and let you decide whether the math works for your situation than dress up a denial as a win.