Not long ago, ketamine therapy and transcranial magnetic stimulation (TMS) were seen as unconventional options—something you’d only hear about on the fringes of mental health treatment. Today, that’s changed in a big way. These therapies are becoming a regular part of outpatient care across the U.S., showing up in both specialized clinics and traditional psychiatry practices. Recent reporting suggests there are now hundreds of ketamine clinics operating nationwide—likely somewhere between 500 and 700. At the same time, many behavioral health providers are investing in TMS technology and FDA-approved esketamine (Spravato) programs.
Ketamine’s New Role in Mental Health
Ketamine has actually been around for decades. It was approved back in 1970 as an anesthetic and has long been used in hospitals and emergency settings. But over the past 15–20 years, researchers discovered something important: in low doses, ketamine can quickly reduce symptoms of depression—even in patients who haven’t responded to other treatments. Most of its use in mental health today is considered “off-label.” That means while ketamine itself is approved, using it for depression (typically through IV or IM treatments) isn’t specifically FDA-approved. Still, it’s legal and widely practiced. Patients usually go through a series of treatments over several weeks, sometimes followed by ongoing maintenance sessions. A major turning point came in 2019, when the FDA approved a nasal spray version called Spravato. Unlike traditional ketamine treatments, Spravato must be given in a certified clinical setting under strict safety guidelines. The big difference? It’s often covered by insurance, including Medicare.
What Is TMS, and Why Is It Growing?
TMS is a completely different approach. Instead of medication, it uses magnetic pulses to stimulate specific areas of the brain. A device is placed on the scalp, and patients remain fully awake during treatment. The FDA first cleared TMS in 2008 for patients with depression who didn’t respond to antidepressants. Since then, it’s also been approved for conditions like OCD. Treatment typically involves frequent sessions—about five times a week for four to six weeks. Side effects are usually mild, like scalp discomfort or headaches. While seizures are a known risk, they’re rare when proper protocols are followed. Because TMS is FDA-cleared and follows standardized guidelines, insurance companies are generally more comfortable covering it. Many psychiatry practices now rely on TMS and Spravato as key revenue drivers. From an insurance perspective, this also means something important: many mental health practices are no longer “low-risk” operations. They now use advanced equipment and treat more complex cases.
Who’s Offering These Services?
There’s a wide range of providers in this space, and each comes with its own risks and considerations.
Standalone ketamine clinics
Often run by anesthesiologists, psychiatrists, or nurse practitioners, these clinics tend to focus only on ketamine treatments. Many operate on a cash-pay model and may have smaller teams or limited operating history.
Psychiatry practices with interventional services
More traditional practices are adding TMS, Spravato, and sometimes ketamine into their offerings. These tend to combine insurance-based care with ongoing psychiatric treatment.
Hospitals and academic centers
Larger health systems are building formal programs with structured protocols and multidisciplinary teams. While they often have stronger oversight, the potential severity of claims can be higher.
Telehealth and hybrid models
Some companies now combine virtual care with at-home ketamine treatments. This model introduces additional regulatory and compliance challenges, especially as rules continue to evolve.
What Comes Next
There’s a lot more to understand about how these treatments work, how they’re regulated, and how to properly insure them. If you are considering offering ketamine or TMS services, a specialist at CAPIA can help educate and guide you to the right medical professional liability coverage for your needs.
