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Ketamine and Medicare?

After three long years trying to get through to someone - anyone - at the Centers for Medicare and Medicaid Services (CMS), we have progress! On Thursday, October 26, 2023, I will be meeting with Dr. Susan Miller, Lead Medical Advisor with the CMS Coverage and Analysis Group, as well as Joanna Baldwin, Deputy Director of the Division of Evidence and Policy Review and Linda Gousis, Technical Advisor in the Coverage and Analysis Group, to discuss the need for a National Coverage Determination (NCD). An NCD would require all Medicare regions and Medicare insurance plans (Medicare Advantage, Medicare Supplement) to cover ketamine infusions!

This is doubtless going to be a long and arduous journey, but it is at least a first step!

We have a letter from October 2021, where the Deputy Director of CMS states that ketamine infusions for Major Depressive Disorder and Suicidal Ideation does meet the federal statutory definition of "medically accepted," as well as meeting other regulatory requirements. Daniel Tsai states in that letter that CMS encourages Medicaid programs to cover ketamine infusions. Yet, two years later, Medicare itself is still not providing coverage!

Stay tuned on this important matter!

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