Ketamine Infusions for Depression

aknoper

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Arvada, CO
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Hello,
Our office is looking into providing Ketamine IV Infusions for Depression (not the nasally administered Esketamine). I know that this is considered off label and insurance will not pay for it. I've read some conflicting information that even though insurance does not pay for the Ketamine itself we would potentially still bill insurance for the IV placement and continual monitoring that takes place. Anyone have any insight on this? I feel like if we are administering a drug that is not covered for a diagnosis they consider experimental then we shouldn't be able to bill for those things at all? I've just searched and searched and cannot get any clarification on this. Any help is appreciated!
 
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Location
Perry, UT
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Oh my gosh! I searched for the same information for months! I'm still on the lookout for anything about it. The office I work in does Ketamine injections and Spravato both. We are seeing a lot of patients benefit from each of them, it's just some people respond better to one over the other. Spravato is covered by most insurances with a prior auth and it is billed through a specialty pharmacy and sent to us directly. So we have nothing to do with buying/supplying the medication. We have had success billing the E&M code and the prolonged service code for the amount of time spent.

Ketamine is a different story. You are correct, insurance won't cover it for mental health diagnoses. We purchase the medication and have it on hand. So far we have only done self pay for it and that has worked out well. We have 2 patients with CRPS who come in for Ketamine injections and we have billed and been paid for their claims. So, when I spoke to one of our provider reps about billing for Spravato visits, I asked specifically about Ketamine. She said because it's not a covered benefit, it wouldn't matter if we billed it, they would deny regardless. We are billing 99215 x1 and 99417 or G2212 (depending on your payer following Medicare guidelines or not times) x the # of units of prolonged service is documented. We bill these codes for Spravato patients and our CRPS patients and have been successful in being paid by our major payers (BCBS, Cigna, UHC & Select Health). Because of what our rep told us, we are talking about submitting claims for our Ketamine visits and hopefully they will pay, like they do with Spravato.

This has been my personal experience with all this. But I would recommend you contact your network providers and ask them about their stance on the subject, especially since you would be billing for infusions, not injections. I have searched every insurance carrier for any policies regarding Ketamine and found none. Some of them mention Ketamine in their Spravato policies, if they even have one.

I hope this has answered some of your questions. Feel free to contact me if you have any other questions or issues with it. Have a good evening!
 

aknoper

New
Messages
4
Location
Arvada, CO
Best answers
0
Oh my gosh! I searched for the same information for months! I'm still on the lookout for anything about it. The office I work in does Ketamine injections and Spravato both. We are seeing a lot of patients benefit from each of them, it's just some people respond better to one over the other. Spravato is covered by most insurances with a prior auth and it is billed through a specialty pharmacy and sent to us directly. So we have nothing to do with buying/supplying the medication. We have had success billing the E&M code and the prolonged service code for the amount of time spent.

Ketamine is a different story. You are correct, insurance won't cover it for mental health diagnoses. We purchase the medication and have it on hand. So far we have only done self pay for it and that has worked out well. We have 2 patients with CRPS who come in for Ketamine injections and we have billed and been paid for their claims. So, when I spoke to one of our provider reps about billing for Spravato visits, I asked specifically about Ketamine. She said because it's not a covered benefit, it wouldn't matter if we billed it, they would deny regardless. We are billing 99215 x1 and 99417 or G2212 (depending on your payer following Medicare guidelines or not times) x the # of units of prolonged service is documented. We bill these codes for Spravato patients and our CRPS patients and have been successful in being paid by our major payers (BCBS, Cigna, UHC & Select Health). Because of what our rep told us, we are talking about submitting claims for our Ketamine visits and hopefully they will pay, like they do with Spravato.

This has been my personal experience with all this. But I would recommend you contact your network providers and ask them about their stance on the subject, especially since you would be billing for infusions, not injections. I have searched every insurance carrier for any policies regarding Ketamine and found none. Some of them mention Ketamine in their Spravato policies, if they even have one.

I hope this has answered some of your questions. Feel free to contact me if you have any other questions or issues with it. Have a good evening!
Thank you so much for your response! I sent you an email with a few additional questions if you have time. Thanks again!
 
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