Key takeaways

  • Medicare doesn’t cover ketamine infusion therapy, though it may cover a nasal spray made with esketamine (a ketamine derivative) in certain cases.
  • Medicare considers Ketamine therapy as “investigational” and not medically necessary when used for chronic pain, most mental health conditions, or migraine episodes.
  • Medicare will only cover ketamine formulations that are FDA-approved for use as an anesthetic or nasal spray.

Ketamine may be prescribed as an off-label oral, infusion, injection, or nasal treatment for a variety of conditions.

Although Medicare covers some off-label treatments, the off-label use of ketamine doesn’t meet the criteria for coverage at this time.

Ketamine therapy is “investigational” and, as such, is not considered medically necessary for chronic pain, most mental health conditions, or migraine episodes.

That means Medicare will not cover ketamine infusion therapy. Medicare will cover only ketamine formulations approved by the Food and Drug Administration (FDA) for use as an anesthetic or nasal spray.

Ketamine is made up of two mirror-image molecules, R-ketamine and S-ketamine.

R-ketamine is also known as arketamine, racemic ketamine, or ketamine hydrochloride (Ketalar). It is an FDA-approved anesthetic that’s administered as an intramuscular injection (shot) or intravenous (IV) infusion.

Healthcare professionals use it to induce general anesthesia for procedures that do not require muscle relaxation. It may be used alone or alongside other medications, such as nitrous oxide.

S-ketamine, also known as esketamine (Spravato), is an FDA-approved nasal spray for treatment-resistant depression and major depressive disorder with suicidal ideation or behavior.

Esketamine (Spravato) must be used in combination with an oral antidepressant.

Original Medicare includes Part A (hospital insurance) and Part B (medical insurance).

Medicare Advantage, also known as Part C, bundles hospital and medical coverage with additional health and wellness benefits. This often includes prescription drug coverage (Part D).

Part A

Part A covers anesthesia services, including R-ketamine, during an inpatient stay at a hospital or skilled nursing facility.

Most people do not have to pay a monthly premium for Part A. If you don’t meet the criteria for premium-free Part A in 2025, you’ll pay $285 or $518 monthly.

After you meet your deductible — $1,676 for each inpatient hospital benefit period — you’ll pay a copay or coinsurance amount for all Medicare-approved services.

Part B

Part B covers anesthesia services, including R-ketamine, provided in an emergency room, urgent care center, or other outpatient setting.

Part B also covers S-ketamine. The medication must be administered by your prescribing physician in a licensed facility, so it isn’t eligible for other forms of prescription drug coverage.

Most people pay a monthly premium of $185 for Part B, but your premium may be higher depending on your income.

After you meet a $257 deductible, you’ll generally pay 20% of all Medicare-approved costs for covered services.

Part C

Part C plans are required to cover the same basic services as Original Medicare, including the use of anesthesia and other outpatient prescription drugs administered by a healthcare professional.

Each Part C plan sets its own cost and coverage amounts. That means the premiums, deductibles, copayments, and coinsurance amounts you’re responsible for depend on your chosen plan.

Staying in network — which means getting care from a predetermined list of approved healthcare professionals and facilities — generally costs less than going out of network.

Part D

Stand-alone prescription drug plans pay for prescription medications that Original Medicare doesn’t cover. This means that Part D will not cover R-ketamine and S-ketamine.

Even if you have a Medicare Advantage plan with prescription drug coverage, R-ketamine and S-ketamine medications will still be covered under Part B.

Although the FDA has approved ketamine for use as an injected or intravenous anesthetic, ketamine infusion therapy hasn’t been approved to treat chronic pain, depression, or other conditions.

Esketamine nasal spray is the only FDA-approved ketamine therapy for depression. Certain diagnostic criteria must be met for Medicare to cover the use of esketamine.

Original Medicare and Medicare Advantage cover ketamine and its derivatives as a medically necessary anesthetic or nasal spray administered by a healthcare professional.