One of the first practical questions people ask when they’re researching ketamine-based treatment is whether insurance will pay for it. It’s a fair question, and the answer depends on which type of treatment you’re talking about — because Spravato and ketamine therapy are treated very differently by insurance companies.
Here’s a straightforward breakdown of what’s covered, what isn’t, and what the process looks like at Rivendell Health.
Spravato (esketamine): Covered by most major insurance plans when you meet the clinical criteria. Prior authorization is required.
Ketamine therapy: Not covered by insurance. It is always an out-of-pocket expense.
That gap exists for a specific reason, and understanding it helps set realistic expectations before you pick up the phone.
The difference in coverage comes down to FDA approval status, not clinical effectiveness.
Spravato received FDA approval in 2019 for two specific indications: treatment-resistant depression (TRD) and major depressive disorder (MDD) with acute suicidal ideation or behavior. Because it’s FDA-approved for those uses, insurance companies have an established framework for covering it.
Ketamine is used off-label for psychiatric conditions. Ketamine’s only FDA approval is as a general anesthetic — which means insurance companies classify psychiatric ketamine treatment as off-label use and exclude it from coverage, regardless of the clinical evidence supporting them. That distinction is rooted in regulatory and administrative processes, not in a judgment about whether the treatment works.
The practical implication: if Spravato is clinically appropriate for your situation, insurance coverage makes it significantly more accessible. If your provider determines that ketamine is the better fit, you’ll be paying out of pocket.
Spravato is covered by most major commercial insurance plans, including Aetna, UnitedHealthcare, Cigna, Anthem Blue Cross Blue Shield, and others. Medicare Part B also covers Spravato when it’s administered in a certified clinical setting. Tricare often covers it for eligible beneficiaries.
Coverage is not automatic — it requires prior authorization, and insurers apply specific clinical criteria before approving treatment. The criteria vary somewhat by insurer, but generally require:
The REMS (Risk Evaluation and Mitigation Strategy) program is a requirement from the FDA. Because Spravato can cause dissociation, sedation, and temporary blood pressure changes, it must be self-administered under clinical supervision, and patients are monitored for at least two hours after each session. Rivendell Health is a certified REMS site, which is a requirement for insurance coverage to apply.
Initial authorizations are typically approved for up to 12 months for treatment-resistant depression, with reauthorization available based on documented clinical response.
Ketamine for psychiatric conditions is not covered by insurance. Because ketamine lacks FDA approval for mental health use, no insurance plan will pay for it, whatever your diagnosis or treatment history.
At Rivendell Health, ketamine therapy is given by injection. If this is the treatment your provider recommends, it will be an out-of-pocket cost, and our front office can give you pricing.
You can use health savings account (HSA) funds toward the cost of ketamine therapy.
For Spravato, prior authorization is a standard step — not a barrier. It’s a documentation process in which your provider submits clinical records to your insurer demonstrating that you meet the coverage criteria.
At Rivendell Health, our team handles the prior authorization process on your behalf. That includes gathering the required documentation, submitting the request, and following up with your insurer. You won’t be navigating that process alone.
What you can do to help the process move smoothly:
Your insurer may request additional documentation or ask for a peer-to-peer review between your provider and their medical team. These steps are common and don’t indicate a denial is coming — they’re part of how prior authorization works for higher-cost specialty treatments.
Medicare: Medicare Part B covers Spravato when administered in a REMS-certified outpatient setting. After the 2025 Part B deductible of $257 is met, Medicare covers 80% of eligible costs, with the patient responsible for the remaining 20% — unless you have supplemental coverage that offsets that amount. Medicare does not cover ketamine therapy for psychiatric conditions.
Medicaid: Coverage varies significantly by state. Colorado Medicaid coverage for Spravato should be verified directly with your plan before starting treatment. Do not assume coverage without confirming.
Tricare: Tricare often covers Spravato for eligible beneficiaries, though coverage depends on your plan and situation. Given the significant veteran and military population in Colorado Springs, this is worth noting specifically. Tricare does not cover ketamine therapy.
At Rivendell Health, we offer both Spravato and ketamine therapy. During your initial evaluation, your psychiatric provider will determine which option is clinically appropriate for your situation — and that recommendation will factor in your diagnosis, your treatment history, and your insurance coverage.
If Spravato is the right fit, our team will handle the prior authorization process and work with your insurer to confirm your benefits before treatment begins. If ketamine is recommended, it is self-pay, and our front office can tell you the cost before you start.
The goal is a clear picture of your clinical options and your costs before treatment starts — not surprises after the fact.
If you have questions about coverage before scheduling, you’re welcome to call our office directly at (719) 726-6573. Otherwise, the first step is a consultation with our psychiatric team.
Phone: (719) 726-6573
Fax: (719) 698-7879
Email: support@RivendellHealth.com
Location: 1465 Kelly Johnson Blvd. Ste 310
Colorado Springs, CO 80920
Hours: