Written by Deborah Tan, Avesta Ketamine Wellness Co-CEO
In this Post:
- Factors Influencing Ketamine Therapy Cost
- Comparing Prices Across Treatment Types
- IV Infusions Cost
- Spravato Cost (with and without insurance)
- Generic Ketamine Nasal Spray Cost
- Oral Tablets Cost
- Intramuscular Injections Cost
- Navigating Insurance Coverage
- Financial Assistance and Support Options
- FAQs about Ketamine Therapy Costs
Ketamine therapy is a powerful treatment for several conditions, including mental health concerns, pain, and substance use disorders.
Unfortunately, ketamine therapy prices can be a significant hurdle. So, how much is ketamine therapy? One clinical ketamine session ranges from about $275 to $1300, depending on the treatment type, insurance coverage, facility, location, and staff experience. Prescription ketamine costs less than in-clinic treatments but comes with potential risks.
This article delves into the factors driving ketamine therapy cost, exploring insurance coverage, reimbursement options, and general pricing for infusions, tablets, and sprays.
Factors Influencing the Cost of Ketamine Therapy
Several factors determine ketamine therapy cost. These elements vary significantly from one treatment center to another and may impact affordability and accessibility.
Type of treatment
There are four main methods of administering ketamine therapy:
- Intravenously (IV)
- Intramuscularly (IM)
- Orally
- Intranasally
Each route has different associated costs. For example, intravenous ketamine therapy, where patients are monitored in-clinic by healthcare professionals, is generally more expensive than at-home oral lozenges or intranasal sprays.
At-home treatments are more affordable. But, unsupervised ketamine therapy comes with potential dependence and overdose risks. Avesta strongly believes that in-clinic ketamine therapy supervised by experienced medical professionals is essential for patient safety and treatment effectiveness.
Ketamine Facility
The ketamine clinic location and the type of facility can also significantly influence treatment costs. Ketamine centers in major cities like Washington D.C. and New York typically charge higher prices than those in more remote areas due to higher overhead expenses like rent and staff salaries.
Additionally, private clinics often charge more for ketamine therapy than hospitals due to specialized staff, advanced equipment, and a more personalized approach.
Ancillary Services
Ketamine therapy costs generally exceed the medicine itself. That’s because protocols include ancillary services that patients must pay for. These services include psychotherapy sessions, consultations, counseling, and follow-ups.
Staff experience
Ketamine clinics that employ independent licensed practitioners and trained medical assistants generally must charge more than centers with less specialized patient-care technicians.
Trained ketamine professionals have a deeper understanding of dosage, risks, safe handling of side effects, patient management, and protocols. This expertise warrants higher salaries and training costs, reflected in the overall treatment fees.
Comparing Ketamine Therapy Costs Across Treatment Types
Treatment type is a major factor influencing ketamine therapy cost.
IV infusions
IV ketamine infusions are typically the most expensive treatment type out of pocket. Depending on the provider, one 40-60-minute IV ketamine session can start at around $400 and reach or exceed $1,000, depending on the city and level of care.
According to the American Society of Ketamine Physicians, Psychotherapists & Practitioners, $400 to $800 per ketamine treatment is reasonable. Any more than that may be “asking too much.”
Most IV ketamine induction protocols consist of four to six treatments over two to three weeks, translating to an average of $2,000 to $4,000 total. Avesta strictly follows research protocols, consisting of at least six treatments over two to three weeks, before moving to a maintenance protocol.
Intranasal sprays
Intranasal spray costs range depending on whether the patient receives generic ketamine or ketamine-analog esketamine. Price also depends on insurance coverage.
Spravato Costs (with and without insurance)
The FDA recently approved the esketamine intranasal spray, Spravato, in 2019.
Medication Costs
- Without insurance, the Spravato medication costs about $600 for a 56mg dose and $900 for 84mg.
- With insurance, eligible patients can pay as little as $10 per Spravato treatment for medication costs.
Spravato patients must also pay monitoring fees, as they receive the medication in clinics under medical supervision, similar to IV sessions.
Monitoring Costs
- Without insurance coverage, Spravato monitoring can cost $200 – $400 per visit.
- With insurance, eligible patients can pay as little as a standard co-pay (typically $30 – $50).
With medication and monitoring costs, uninsured Spravato treatments range from about $900 to as high as $1,300 per visit. Patients with coverage can pay $40 – $60 per treatment.
Spravato protocols require a twice-weekly dosage for four weeks, followed by a once-per-week session for another month. After eight weeks, patients generally taper down to every other week. Some patients discontinue treatment depending on their needs.
Total Spravato Protocol Costs
- Uninsured Spravato patients could pay $10,800 – $15,600 out of pocket for the eight-week protocol, consisting of 12 sessions.
- Insured Spravato patients could pay as little as $480 to $720 for the eight-week protocol.
Generic Ketamine Nasal Spray
Locally compounded ketamine intranasal sprays cost significantly less than Spravato, about $100–$200 per 30 ml bottle.
Patients typically take generic ketamine sprays at home without medical supervision, which can lead to risks. The FDA recently issued a warning for compounded ketamine nasal sprays, citing adverse psychiatric events, misuse, and abuse stemming from a lack of standardization and safety measures. The FDA urged medical professionals to prescribe generic ketamine spray cautiously and report any adverse events.
Oral tablets
Ketamine oral tablets are the least expensive treatment because they are at-home medications.
Tablets, also called troches or lozenges, cost anywhere from $75 to $200 per prescription, with the total amount depending on the number of tablets the patient needs. Like nasal sprays, ketamine tablets should be prescribed carefully and with a complete medical management picture in mind.
Intramuscular Injections
Intramuscular ketamine (IM) injections are not as popular as IV ketamine because of dosage control issues. However, some patients have reported they can be as effective and enjoy the strong “high” the IM injection can induce.
Each IM ketamine session generally costs $275 to $300 plus potential monitoring fees. With a therapist or facilitator involved, each IM session typically costs $400+. It is crucial to choose a facilitator who can monitor patients with the safety equipment AND medical knowledge, and licensing to react in a crisis.
Most intramuscular patients receive the same number of injections as IV patients. Thus, a four-to-six IM ketamine protocol generally costs $1,600 to $2,400.
Navigating Insurance for Ketamine Treatments
Insurance plans, including Medicaid and Medicare, typically exclude ketamine treatment from coverage. That’s because the FDA has not approved ketamine specifically for mental health or chronic pain, only as an anesthetic. Clinicians must administer ketamine off-label because of this issue.
Spravato is the exception. Some insurance plans cover this esketamine nasal spray because it is FDA-approved., However, patients must request pre-authorization and receive specific diagnoses to qualify for coverage.
In some instances, patients receiving IV ketamine infusions may also receive partial or complete insurance coverage. For example, insurers sometimes cover ancillary ketamine therapy costs, such as consultation and screening appointments. Patients must communicate with their insurance provider to determine options before beginning treatment.
Avesta has been working to expand access to ketamine therapy treatments and is proud to be in-network with the VA (Veterans Affairs). Veterans with coverage should contact their VA offices and request an Avesta referral for IV ketamine and Spravato treatments.
Avesta has also received Workman’s Compensation Coverage approval and will soon be in-network with select payers.
Tips for Discussing Ketamine Treatment Coverage With Insurance Providers
Before scheduling ketamine treatment:
- Patients should call their insurer to request ketamine coverage information. Upon first contact, patients should ask for a reference number and the representative’s name to streamline communication and track inquiries.
- Patients should confirm if their plan covers ketamine treatment and, if so, to what extent. Asking about specific inclusions such as infusions and consultations can help avoid unexpected bills.
- Since most ketamine clinics fall outside the coverage network, patients should also check for out-of-network options. This can help determine all out-of-pocket expenses.
For patients with partial coverage:
Patients can determine partial coverage options by sending ketamine billing codes to their insurer before treatment. Common codes include:
- 96365: This code covers the actual IV infusion.
- 99214: This code covers the doctor’s consultation and assessment.
Financial Assistance and Support Options
HSA/FSA Accounts: Health and flexing savings accounts (HSA/FSA) are pre-tax accounts patients can use to fund ketamine therapy. Patients must be enrolled in a high-deductible health plan (HDHP) to be eligible for them. Avesta accepts both Health HSA and FSA as payment options for ketamine therapy.
Paying in installments: Patients can also pay for ketamine therapy in installments to reduce upfront costs. Ketamine clinics sometimes offer payment plans and work closely to ensure all patients can access the healing therapy they need.
Medical credit: Another way to finance ketamine therapy is through credit. Avesta partners with Advance Care Card to offer patients this option with competitive interest rates.
Special provisions for military veterans: Some facilities offer discounted ketamine therapy rates for current and retired military personnel who meet specific eligibility criteria. Avesta partners with Ten Ten Life, a 501(c)(3) nonprofit, to provide trauma-informed counseling and professional coaching services to military members and veterans.
FAQs About Ketamine Therapy Cost
Does insurance cover ketamine infusions?
Generally, insurance does not cover ketamine infusions. However, in some cases, insurance companies might partially reimburse patients who’ve demonstrated that ketamine therapy is necessary after traditional treatments have failed.
How much is ketamine therapy near me?
Ketamine therapy prices vary depending on the region, but cities are generally more expensive than rural areas. IV ketamine sessions start at $400 each. IM begins at $275. Lozenges start at $75. Generic nasal sprays start at $100, and uninsured Spravato begins at $900 with monitoring fees.
Are there additional costs associated with ketamine therapy apart from the treatment itself?
Yes, additional costs associated with ketamine therapy may include initial consultation fees, monitoring, maintenance or follow-up treatment sessions, and supplementary therapies or medications. There are also non-monetary costs, such as time off work for treatment.
Are there low-cost or financing options available for ketamine therapy?
Yes, there are low-cost or financing options available for ketamine therapy. These options vary depending on the clinic, with some offering sliding scale fees, payment plans, or assistance programs.
Patients should contact Avesta’s Virginia, Maryland, and Washington D.C. clinics to learn about its ketamine price as well as insurance and other financing options.
Ketamine Therapy For Depression, PTSD, Anxiety, Chronic Pain in DC, Maryland and Virginia
