Medical Billing Forum

Billing => Billing => : Ruthie1972 September 04, 2018, 06:56:16 PM

: ketamine therapy
: Ruthie1972 September 04, 2018, 06:56:16 PM

Hello,
Does anyone have any experience with billing Medicare for Ketamine Therapy? Do you know what ICD10 codes they will pay for? we are using a Depression code and it is getting denied. Thank you.

: Re: ketamine therapy
: PMRNC September 05, 2018, 10:32:10 AM

Ketamine is still considered investigational/experimental for mental health diagnosis. Insurance carriers only seem to be covering it for pain and prior to anesthesia. This is from a 2018 memo from UHC I found:

Ketamine is considered medically necessary and may be covered for:
- Anesthesia for diagnostic and surgical procedures that do not require skeletal muscle relaxation
- The induction of anesthesia prior to administration of other anesthesia agents
-. As supplemental anesthesia for low-potency agents, such as nitrous oxide

Ketamine is investigational, and therefore not proven or medically necessary for:
- Psychiatric disorders (including, but not limited to depression, bipolar disorder, & posttraumatic stress disorder)
- Chronic pain (including but not limited to nonmalignant pain, Fibromyalgia, neuropathic pain, Complex Regional
Pain Syndrome, Reflex Sympathetic Dystrophy)
- Migraine headaches

: Re: ketamine therapy
: Ruthie1972 November 30, 2018, 12:53:50 PM

Thank you so much Linda.

Have a good day.