By Michael Alvear, Health Author & Independent Researcher

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Last Updated: December 5, 2025

Does Kaiser Permanente Cover IV, Injection and Oral Ketamine?

The ketamine policy treats ketamine given by intranasal, intravenous, or subcutaneous routes as experimental for psychiatric conditions and lists depression as a non-covered diagnosis. It does not spell out any coverage criteria for oral or sublingual ketamine.

Important fine print for Kaiser members

• This summary is based on Kaiser Foundation Health Plan non-Medicare clinical review criteria for ketamine for depression and other psychiatric disorders, as published in the ketamine criteria document “Ketamine for the Treatment of Depression and Other Psychiatric Disorders” and the related clinical review criteria resources.
• Kaiser notes that these clinical review criteria are tools used to administer plan benefits and do not offer medical advice or guarantee coverage; your actual contract and benefit documents control.
• Benefits can vary by employer group and specific product. To confirm your own situation, check your Evidence of Coverage or benefit booklet and call the Member Services number on your ID card.

Does HCSC (BCBS IL/TX/NM/OK/MT) Cover IV, Injection and Oral Ketamine?

The Blue Review article on ketamine infusion therapy describes intravenous ketamine infusions for psychiatric disorders as experimental, investigational and/or unproven, which is the language the plan uses for non-covered services. The newsletter references medical policy SUR702.016 for IV anesthetics, but public materials do not outline any coverage criteria for injection or oral ketamine for depression.

Important fine print for HCSC (BCBS IL/TX/NM/OK/MT) members

• This summary is based on ketamine infusion information from the Blue Review article “Blue Review – Fighting Fraud, Waste and Abuse: Ketamine Infusion Therapy (BCBSIL)”, the related Blue Review PDF newsletter, and the general medical policy index that references SUR702.016 for IV anesthetics.
• These materials describe how the plan evaluates ketamine services but do not guarantee payment for any specific member, diagnosis, clinic, or claim.
• Your actual benefits depend on your individual contract, so always review your Evidence of Coverage and call the Member Services number on your ID card before scheduling treatment.
• HCSC and its affiliated Blue Cross and Blue Shield plans operate in multiple states and product lines, and Medicare, Medicaid, or other products may have different ketamine rules than those summarized here.

Does UnitedHealthcare Cover IV, Injection and Oral Ketamine?

The commercial Ketalar/Spravato medical benefit drug policy classifies ketamine injection as investigational and not medically necessary for psychiatric disorders including depression. The coverage rationale treats ketamine injection for conditions such as depression, bipolar disorder, and posttraumatic stress disorder as not proven or medically necessary, and the policy does not spell out any coverage criteria for oral or sublingual ketamine for depression.

Important fine print for UnitedHealthcare members

• This summary is based on the UnitedHealthcare commercial Ketalar/Spravato medical benefit drug policy and related materials, including the policy document “Commercial – national Ketalar/Spravato medical benefit drug policy”, the commercial medical and drug policy index, and the commercial medical policy update bulletin.
• These materials describe how the plan evaluates ketamine services but do not guarantee payment for any specific member, diagnosis, clinic, or claim.
• Your actual benefits depend on your individual contract, so always review your Evidence of Coverage and call the Member Services number on your ID card before scheduling treatment.
• UnitedHealthcare administers multiple product lines, and employer plans, Medicare, Medicaid, or other products may have different ketamine rules than those summarized here.

Anthem Blue Cross Blue Shield: IV, Injection, and Oral Ketamine Coverage for Depression

The CarelonRx ketamine injection clinical criteria limit approval of Ketalar to anesthesia and certain acute pain indications. For all other indications, including major depressive disorder and other psychiatric conditions, ketamine injection is described as a drug that may not be approved, and the document does not outline any coverage criteria for oral or sublingual ketamine for depression.

Important fine print for Anthem Blue Cross Blue Shield members

• This summary is based on CarelonRx ketamine injection clinical criteria used for Anthem commercial plans, including the document “Clinical Criteria – Ketalar (ketamine injection)”, the CarelonRx clinical criteria index, and the Anthem pharmacy clinical criteria page.
• These criteria describe how ketamine injection requests are evaluated but do not guarantee payment for any specific member, diagnosis, clinic, or claim.
• Your actual benefits depend on your individual contract, so always review your Evidence of Coverage and call the Member Services number on your ID card before scheduling treatment.
• Anthem operates in multiple states and product lines, and employer plans, Medicare, Medicaid, or other products may have different ketamine rules than those summarized here.

Does Aetna Cover IV, Injection and Oral Ketamine?

The clinical policy bulletin on ketamine for depression explains that Aetna considers ketamine given intramuscularly, intranasally, intravenously, orally, or subcutaneously experimental, investigational, or unproven for depression. In this policy language, a service labeled experimental or unproven is not treated as a covered benefit for depressive disorders.

Important fine print for Aetna members

• This summary is based on Aetna clinical policy bulletins including “Ketamine for the Treatment of Depression and Other Selected Indications (CPB 0938)”, the related bulletin CPB 0950, and the general Aetna medical clinical policy bulletin index.
• These bulletins describe how Aetna evaluates ketamine services but do not guarantee payment for any specific member, diagnosis, clinic, or claim.
• Your actual benefits depend on your individual contract, so always review your Evidence of Coverage and call the Member Services number on your ID card before scheduling treatment.
• Aetna offers multiple product lines, and employer plans, Medicare, Medicaid, or other products may have different ketamine rules than those summarized here.

Does Florida Blue Cover IV, Injection and Oral Ketamine?

The Spravato nasal spray medical coverage guideline is the only Florida Blue policy that addresses a ketamine-based treatment for depression, and it focuses solely on intranasal esketamine. The guideline notes that Spravato is for nasal use only and that the patient is not receiving concomitant ketamine therapy, without outlining any coverage position for IV, intramuscular, subcutaneous, oral, or sublingual ketamine.

Important fine print for Florida Blue members

• This summary is based on Florida Blue Spravato nasal spray materials, including the medical coverage guideline “Spravato (esketamine) Nasal Spray – Medical Coverage Guideline (PH-0481/09-J3000-37)”, the policy page Spravato (esketamine) Nasal Spray – Medical Policies, and the broader medical policies and coverage guidelines index.
• These documents describe how Spravato requests are evaluated but do not guarantee payment for any specific member, diagnosis, clinic, or claim.
• Your actual benefits depend on your individual contract, so always review your Evidence of Coverage and call the Member Services number on your ID card before scheduling treatment.
• Florida Blue and related plans may have different rules across product lines, and separate policies for Spravato, IV ketamine, or other treatments may apply to Medicare, Medicaid, or employer-specific benefits.

Does Cigna Healthcare Cover IV, Injection and Oral Ketamine?

The outpatient Ketalar coverage criteria state that ketamine intravenous use for any outpatient indication, including major depressive disorder, is considered not medically necessary. Publicly available materials do not describe coverage criteria for other ketamine injection routes or for oral or sublingual ketamine for depression, so these routes function like cash-pay options in practice.

Important fine print for Cigna Healthcare members

• This summary is based on Cigna Healthcare pharmacy coverage policies, including the Ketalar coverage position in “Unassigned Drug Code Outpatient Medical Precertification – Ketalar (ketamine intravenous)”, the coverage criteria for compounded medications, and the esketamine nasal spray coverage criteria.
• These documents describe how requests for Ketalar and related therapies are evaluated but do not guarantee payment for any specific member, diagnosis, clinic, or claim.
• Your actual benefits depend on your individual contract, so always review your Evidence of Coverage and call the Member Services number on your ID card before scheduling treatment.
• Cigna Healthcare offers multiple product lines, and employer plans, Medicare, Medicaid, or other products may have different ketamine rules than those summarized here.

Does Ambetter Cover IV, Injection and Oral Ketamine?

The Ketalar clinical policy for Ambetter lays out criteria for intravenous ketamine in treatment-resistant depression and major depressive disorder, requiring IV administration plus multiple failed antidepressant treatments. The same documents do not create any explicit coverage pathway for intramuscular, subcutaneous, oral, or sublingual ketamine for depression, so those routes are left undefined.

Important fine print for Ambetter members

• This summary is based on Ambetter and Centene pharmacy policies, including “Clinical Policy: Ketamine (Ketalar) – CP.PMN.296”, the related ketamine policy at CP.PMN.199, and other materials in the Ambetter pharmacy policy library.
• These criteria describe how requests for ketamine are evaluated but do not guarantee payment for any specific member, diagnosis, clinic, or claim.
• Your actual benefits depend on your individual contract, so always review your Evidence of Coverage and call the Member Services number on your ID card before scheduling treatment.
• Centene and Ambetter offer multiple products in different states, and Medicaid, marketplace, employer, or other plan designs may have ketamine rules that differ from what is summarized here.

Does Highmark Blue Cross Blue Shield Cover IV, Injection and Oral Ketamine?

The Highmark intravenous anesthetics policy allows ketamine (Ketalar) to be considered medically necessary for treatment-resistant or major depressive disorder only when all policy criteria are met and states that ketamine not meeting those criteria is considered not medically necessary. The policy focuses on IV infusion and does not create separate coverage determinations for intramuscular, subcutaneous, oral, or sublingual ketamine for depression.

Important fine print for Highmark Blue Cross Blue Shield members

• This summary is based on Highmark commercial medical policy “Intravenous Anesthetics for Off-Label Indications (I-32-012)”, including the section that addresses ketamine (Ketalar) for treatment-resistant and major depressive disorder.
• The policy describes how requests for IV ketamine are evaluated but does not guarantee payment for any particular member, diagnosis, clinic, or claim.
• Your actual benefits depend on your individual contract, so always review your Evidence of Coverage and call the Member Services number on your ID card before scheduling treatment.
• Highmark and affiliated Blue Cross Blue Shield plans may have different rules across states and product lines, and Medicare, Medicaid, or employer-specific plans can use different criteria than those summarized here.

Does Blue Cross NC Cover IV, Injection and Oral Ketamine?

The commercial medical policy on intravenous anesthetics states that IV anesthetics, including ketamine, for chronic pain and psychiatric disorders (including treatment-resistant depression) are considered investigational and not covered. The policy focuses on IV infusions and does not create any explicit coverage pathway for intramuscular, oral, or sublingual ketamine for depression.

Important fine print for Blue Cross NC members

• This summary is based on the Blue Cross NC commercial medical policy “Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders”, including sections that address ketamine as an IV anesthetic.
• The policy describes how requests for IV anesthetics such as ketamine are evaluated but does not guarantee payment for any specific member, diagnosis, clinic, or claim.
• Your actual benefits depend on your individual contract, so always review your Evidence of Coverage and call the Member Services number on your ID card before scheduling treatment.
• Blue Cross NC and related plans may have different rules across products and funding arrangements, and separate criteria can apply to Medicare, Medicaid, or employer-specific plans.

Does Blue Cross Blue Shield of Massachusetts Cover IV, Injection and Oral Ketamine?

The medical policy on esketamine nasal spray and intravenous ketamine explains that IV ketamine can be covered for treatment-resistant depression and certain mental health conditions when specific medical necessity criteria are met. The same materials focus on IV infusions and intranasal esketamine and do not create any explicit coverage pathway for intramuscular, oral, or sublingual ketamine for depression.

Important fine print for Blue Cross Blue Shield of Massachusetts members

• This summary is based on Blue Cross Blue Shield of Massachusetts materials including medical policy “Esketamine Nasal Spray (Spravato) and Intravenous Ketamine for Mental Health Conditions (Medical Policy 087)” and the related prior authorization request form.
• These documents describe how esketamine and IV ketamine requests are evaluated but do not guarantee payment for any specific member, diagnosis, clinic, or claim.
• Your actual benefits depend on your individual contract, so always review your Evidence of Coverage and call the Member Services number on your ID card before scheduling treatment.
• Blue Cross Blue Shield of Massachusetts offers multiple products, and employer plans or other arrangements may have ketamine rules that differ from what is summarized here.

Does Blue Cross Blue Shield of Michigan Cover IV, Injection and Oral Ketamine?

The medical policy on intravenous anesthetics explains that IV anesthetic infusions such as ketamine for psychiatric disorders, including treatment-resistant depression, are considered investigational and not covered. The policy is written around IV administration and does not create explicit coverage criteria for intramuscular, oral, or sublingual ketamine for depression.

Important fine print for Blue Cross Blue Shield of Michigan members

• This summary is based on Blue Cross Blue Shield of Michigan materials including the medical policy “Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders”, related policy documents such as additional anesthetic policy guidance, and provider communications in the ereferrals news and updates.
• These materials describe how requests for IV anesthetics such as ketamine are evaluated but do not guarantee payment for any specific member, diagnosis, clinic, or claim.
• Your actual benefits depend on your individual contract, so always review your Evidence of Coverage and call the Member Services number on your ID card before scheduling treatment.
• Blue Cross Blue Shield of Michigan offers multiple products, and employer plans or other arrangements may have ketamine rules that differ from what is summarized here.

Does Horizon Blue Cross Blue Shield of New Jersey Cover IV, Injection and Oral Ketamine?

The medical policy on intravenous anesthetics classifies IV ketamine infusions for psychiatric disorders, including depression, as investigational and therefore not covered. The policy is limited to IV anesthetic infusions and mentions oral ketamine only in background discussion, without creating any coverage pathway for intramuscular, oral, or sublingual ketamine for depression.

Important fine print for Horizon Blue Cross Blue Shield of New Jersey members

• This summary is based on Horizon policies and communications including the medical policy “Intravenous Anesthetics for the Management of Chronic Pain and Depression (Policy 035)”, the online medical policy section view, and the provider news article “Medical policy revision: intravenous anesthetics for the management of chronic pain and depression”.
• These materials describe how IV anesthetic infusions such as ketamine are evaluated but do not guarantee payment for any specific member, diagnosis, clinic, or claim.
• Your actual benefits depend on your individual contract, so always review your Evidence of Coverage and call the Member Services number on your ID card before scheduling treatment.
• Horizon Blue Cross Blue Shield of New Jersey offers multiple products, and employer plans, Medicaid, Medicare, or other arrangements may have ketamine rules that differ from what is summarized here.

Does Independence Blue Cross Cover IV, Injection and Oral Ketamine?

The intravenous ketamine and intranasal esketamine policy classifies IV ketamine for depression as experimental and investigational and therefore not covered outside anesthesia or cancer pain indications. The document focuses on IV Ketalar and Spravato and does not describe any coverage path for intramuscular, oral, or sublingual ketamine for depression.

Important fine print for Independence Blue Cross members

• This summary is based on Independence Blue Cross and related plan materials, including medical policy “Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®) (Policy 08.01.80c)” and the corresponding AmeriHealth commercial policy page.
• These documents describe how IV ketamine and Spravato requests are evaluated but do not guarantee payment for any specific member, diagnosis, clinic, or claim.
• Your actual benefits depend on your individual contract, so always review your Evidence of Coverage and call the Member Services number on your ID card before scheduling treatment.
• Independence Health Group and its affiliated plans may have different rules across products and funding arrangements, and employer, Medicaid, or Medicare plans can apply different ketamine criteria than those summarized here.

Does Humana Cover IV, Injection and Oral Ketamine?

The available Humana commercial policy portal does not publish a clear position on IV or other forms of ketamine for depression. In a related Humana Military TRICARE Spravato policy, ketamine administered in any form is explicitly described as not covered for the treatment of depression, which is a strong signal that clinics should not expect routine coverage for IV, injection, oral, or sublingual ketamine through Humana.

Important fine print for Humana members

• This summary is based on Humana policy sources including the Humana Medical and Pharmacy Coverage Policies portal, the Humana Military TRICARE Spravato policy MP22-026E, and the Spravato continued request form at Humana provider resources.
• These materials describe how ketamine and Spravato requests are evaluated in TRICARE and hint at Humana’s broader approach, but they do not guarantee payment for any specific member, diagnosis, clinic, or claim.
• Your actual benefits depend on your individual contract, so always review your Evidence of Coverage and call the Member Services number on your ID card before scheduling treatment.
• Humana offers multiple products, including commercial, military, and other lines of business, and ketamine rules can differ across these products even when they are administered by the same company.

Does Molina Healthcare Cover IV, Injection and Oral Ketamine?

The Spravato esketamine nasal spray clinical criteria document lists intravenous ketamine infusions as not FDA approved and not a covered benefit, treating IV ketamine for depression as an experimental or investigational use. The same materials do not create any coverage pathway for intramuscular, oral, or sublingual ketamine for depression, so those routes are effectively treated as non-covered as well.

Important fine print for Molina Healthcare members

• This summary is based on Molina and Iowa Medicaid materials, including the Spravato esketamine nasal spray clinical criteria document “Spravato esketamine nasal spray clinical criteria IME-PAM-021” and related coverage criteria posted by Iowa HHS at the state’s pharmacy and medical policy site.
• These documents describe how Spravato and ketamine-related services are evaluated but do not guarantee payment for any specific member, diagnosis, clinic, or claim.
• Your actual benefits depend on your individual contract and state program, so always review your Evidence of Coverage or Medicaid member handbook and call the Member Services number on your ID card before scheduling treatment.
• Molina operates plans in multiple states and program types, and Medicaid, marketplace, or other products may have different ketamine rules than those summarized here.

Does Point32Health (Harvard Pilgrim & Tufts Health Plan) Cover IV, Injection and Oral Ketamine?

No publicly available Point32Health policy has been found that clearly states whether IV, intramuscular, oral, or sublingual ketamine for depression is covered or excluded. The available Spravato medical necessity guideline focuses on intranasal esketamine and does not address other ketamine formulations or routes for depression.

Important fine print for Point32Health members

• This summary is based on available Point32Health policy materials including the Spravato medical necessity guideline.
• Point32Health operates Harvard Pilgrim Health Care and Tufts Health Plan, and publicly available policy materials may not reflect all internal coverage determinations for ketamine services.
• Your actual benefits depend on your individual contract, so always review your Evidence of Coverage and call the Member Services number on your ID card before scheduling treatment.
• Point32Health offers multiple products across different markets, and coverage rules may vary significantly between plan types and employer groups.

Does BlueCross BlueShield of Tennessee Cover IV, Injection and Oral Ketamine?

The medical policy on intravenous anesthetics lists intravenous ketamine for treatment-resistant depression and other psychiatric disorders as investigational and not covered. The policy focuses on IV administration and does not create explicit coverage criteria for intramuscular, oral, or sublingual ketamine for depression.

Important fine print for BlueCross BlueShield of Tennessee members

• This summary is based on BlueCross BlueShield of Tennessee materials including the medical policy “Intravenous Anesthetics for the Treatment of Chronic Pain” and related resources at Caremark pharmacy information and BCBST behavioral health provider resources.
• These materials describe how IV ketamine requests are evaluated but do not guarantee payment for any specific member, diagnosis, clinic, or claim.
• Your actual benefits depend on your individual contract, so always review your Evidence of Coverage and call the Member Services number on your ID card before scheduling treatment.
• BlueCross BlueShield of Tennessee offers multiple products, and employer plans or other arrangements may have different ketamine rules than those summarized here.