What OHP Covers for Ketamine, Psilocybin, and Alternative Therapy

Scope note: this page is about the harder coverage questions, ketamine-assisted psychotherapy, psilocybin services, Spravato, and where the line falls between a covered session and an uncovered medicine. If you are looking for the basics of getting therapy paid for on the Oregon Health Plan, start with does OHP cover therapy, then come back here.

Where things stand

A common question among Oregonians exploring alternative mental health modalities is whether the Oregon Health Plan (OHP/Medicaid) or commercial insurance covers treatments like Ketamine-Assisted Psychotherapy (KAP) or Psilocybin Services.

Oregon's Medicaid program (OHP) is administered through Coordinated Care Organizations (CCOs) that vary by region. Each CCO may have slightly different coverage policies, so it is essential to verify benefits directly with your specific plan. Our OHP therapy guide maps every CCO to the counties it serves.

What OHP and Medicaid generally cover

• Psychiatric intake evaluations and diagnostic assessments
• "Preparation" psychotherapy sessions prior to medicine administration
• "Integration" psychotherapy sessions following the medicine experience
• Traditional psychiatric medication management: Spravato (Esketamine) is FDA-approved and sometimes covered for treatment-resistant depression
• Standard outpatient therapy: CBT, EMDR, DBT, and other evidence-based modalities
• Substance use disorder treatment: including MAT (Medication-Assisted Treatment)

What is not covered

• The cost of compounded racemic ketamine lozenges, IM injections, or IV infusions
• The extended 2 to 3 hour clinical observation time during medicine sessions
• Services at licensed Oregon Psilocybin Service Centers (strictly out-of-pocket under Measure 109)
• Experimental or off-label treatments not yet approved by the FDA

What this costs out of pocket

Because the medicine and the observation time usually fall outside coverage, these treatments are priced privately. For context on what Oregon therapists charge generally, see what therapy costs in Oregon. To find clinicians working in these modalities, browse ketamine-assisted providers, psilocybin facilitation, or psychedelic integration therapists.

Sources and official resources

• Oregon Health Authority (OHA). Behavioral Health Fee Schedule and Coverage Guidelines.
• Oregon Psilocybin Services Act (Measure 109). Implementation Guidelines. States that psilocybin services are out-of-pocket, not covered by insurance or OHP.
• Centers for Medicare and Medicaid Services (CMS). Federal rules limit Medicaid and Medicare coverage of experimental treatments.

Disclaimer: Oregon Counselors Directory is an informational resource only. Insurance benefits, state policies, and clinical billing codes change frequently. Always verify coverage with your CCO or MCO and your provider before receiving treatment.