Ketamine and Spravato insurance coverage
Avesta is in-network with more payers than almost any ketamine provider in the DMV. Check your coverage in minutes.
Our Insurance Partners
Avesta is continually working to expand access for this life-saving treatment to more patients
Is Ketamine Covered by Insurance? The Short Answer
At most clinics, IV ketamine infusions are not covered by insurance because ketamine is FDA-approved as an anesthetic, not for depression or pain, so it is administered off-label. Spravato (esketamine) is different: it is FDA-approved for treatment-resistant depression, and most major insurance plans cover it with pre-authorization. Avesta is one of the few ketamine providers in the DC, Maryland, and Virginia region that is in-network for IV ketamine itself, through Cigna, the Veterans Affairs, and Workers’ Compensation.
Insurance Plans Avesta Accepts In-Network
Here is exactly where we stand with each payer today. Coverage varies by individual plan; our insurance specialist verifies your benefits before you commit to anything.
Cigna (including NALC plans) Spravato, IV ketamine, and medication management. Pre-authorization depends on treatment.
Aetna Spravato, in-network at all locations. Pre-authorization required.
Veterans Affairs (VA) Spravato, IV ketamine, and ketamine-assisted psychotherapy (KAP). Requires a VA referral.
CareFirst Spravato and medication management; coming soon.
Virginia Medicaid Spravato and medication management at our Tysons and Norfolk locations. Pre-authorization required.
Maryland Medicaid Spravato and medication management at our Bethesda and Columbia locations. Pre-authorization required.
Workers’ Compensation Spravato, IV ketamine, and medication management at all locations. Pre-authorization required.
Is Spravato Covered by Insurance?
Yes, in most cases. Because Spravato (esketamine) is FDA-approved for treatment-resistant depression and depression with suicidal thoughts, most commercial plans and many Medicaid programs cover it. Requirements typically include a qualifying diagnosis (usually treatment-resistant depression, meaning you’ve tried at least two antidepressants without adequate relief) and pre-authorization.
With coverage, eligible patients can pay as little as $10 per treatment for the medication through the Spravato withMe savings program, plus a standard copay for monitoring. Without insurance, Spravato medication runs $900 to $1,300 per visit and the office visit costs can vary, depending on the clinic.
What happens if my insurance is not listed above?
“Not covered” rarely means paying everything out of pocket. For out-of-network patients, we bill out-of-network on your behalf and provide detailed superbills designed for reimbursement claims, with positive reports from our patients. Depending on your plan, office visits, psychiatric evaluations, medication management, and follow-up appointments may also be covered.
Avesta’s dedicated insurance team has billed for ketamine treatments for years. Their sole focus is to represent you and recover as much from your payer as possible on your behalf. Avesta is out-of-network for all Medicare plans; Medicare patients are still welcome, and we will walk you through your payment options.
What is my estimated payment with insurance?
Avesta estimates are based on your actual out-of-pocket amounts per plan. This estimate depends on your payer and the benefits of your individual plan. Depending on your plan, your out-of-pocket costs could be lowered by $0 to $150 per visit.
For some plans, you may see higher out-of-pocket costs starting out, and lower costs for the rest of the year once your deductible is met. Avesta collects all copays, deductibles, and coinsurance per date of service. Our goal is to lower what you pay for this life-changing treatment.
How to Get Ketamine Therapy Covered by Insurance
- Call your insurer before treatment. Ask whether your plan covers Spravato or Ketamine treatment, which parts (infusions, consultations, monitoring), and what your out-of-network benefits are. Note the representative’s name and a reference number.
- Ask about billing codes. The two most common are 96365 (the IV infusion itself) and 99214 (consultation and assessment). Sending these codes to your insurer before treatment tells you exactly what will be reimbursed.
- Use our superbills. For United Healthcare, Aetna, and BCBS/CareFirst commercial plans, Avesta provides detailed superbills for out-of-network claims.
- Use HSA/FSA funds. Ketamine therapy is an eligible expense for Health Savings and Flexible Spending Accounts.
Avesta is in-network with the Veterans Affairs
IV ketamine, Spravato, and ketamine-assisted psychotherapy (KAP) are approved treatments for patients under the Veterans Affairs, and Avesta is in-network with the VA for all three. Veterans actively receiving care at a Veterans Affairs Medical Center are eligible to be referred to us for these treatments. Click below to learn more about receiving payment for treatments through the VA.
Military members and Veterans: see additional support on our Veterans page below.
What Does Ketamine Therapy Cost Without Insurance?
For a complete breakdown by treatment type, protocol totals, and ways to reduce costs, see our full pricing guide.
Additional Options
Avesta has partnered with Advance Care Card to provide our patients with a credit option. The application only takes a few minutes and you’ll receive an immediate approval decision in most cases. Co-signers may be used to increase chances of approval. Advance Care Card provides patients undergoing healthcare treatments with 6 or 14 months interest-free financing with competitive interest rates.
Frequently Asked Questions
Why is ketamine not covered by insurance? Because the FDA approved ketamine only as an anesthetic, insurers classify its use for depression, anxiety, PTSD, and pain as off-label and exclude it from standard coverage. Spravato, the FDA-approved esketamine nasal spray, is the exception.
Is at-home ketamine treatment covered by insurance? Rarely. At-home compounded ketamine is off-label and typically excluded, and the FDA has warned against compounded ketamine nasal sprays due to safety risks. In-clinic Spravato is the most reliably covered option.
Does Medicare or Medicaid cover ketamine? Avesta is in-network with Virginia Medicaid (Tysons and Norfolk) and Maryland Medicaid (Bethesda and Columbia) for Spravato and medication management. Avesta is out-of-network for all Medicare plans.
How do I find ketamine therapy near me that takes insurance? Look for a certified Spravato center that is in-network with your plan, and ask any ketamine clinic whether they bill out-of-network or provide superbills. Avesta serves the DMV region from five locations: Bethesda, Columbia, Tysons, Washington DC, and Norfolk.
Learn about your options
Our dedicated insurance specialist will verify your benefits, file pre-authorizations, and give you a clear estimate of your out-of-pocket costs before your first appointment. No surprises.