Across the United States, ketamine infusion clinics and transcranial magnetic stimulation (TMS) centers have moved from fringe experiments to visible parts of the mental health system. News coverage from NPR and KFF Health News reports that more than five hundred for-profit ketamine clinics have opened, and some market research estimates between five hundred and seven hundred fifty clinics nationwide.
At the same time, psychiatry practices and behavioral health groups are adding TMS devices and esketamine (Spravato) programs. For retail insurance agents, this is the beginning of a durable new category of outpatient healthcare risk. This first article in a three-part Ethos series explains what these treatments are, who is providing them, and how large the U.S. market has become.
Ketamine is a Schedule III anesthetic that received FDA approval in 1970. For decades it was used mainly in operating rooms and emergency departments. Over the last fifteen to twenty years, researchers have shown that low dose ketamine can rapidly improve depressive symptoms and suicidal thoughts in some patients with severe, treatment resistant depression.
Most psychiatric ketamine use is off-label. That means clinicians are using an approved drug for a non-approved indication. Intravenous or intramuscular ketamine for depression is not specifically approved by the FDA, but it is permitted under general prescribing rules. Clinics usually deliver a series of infusions over several weeks, followed by maintenance treatments.
In 2019, the FDA approved esketamine nasal spray (Spravato) for treatment resistant depression. Spravato must be administered in a certified medical setting under a Risk Evaluation and Mitigation Strategy (REMS). Unlike generic ketamine infusions, Spravato is often reimbursed by Medicare and commercial insurers. Analysts who follow the pharmaceutical market describe Spravato as a fast growing antidepressant franchise for Johnson and Johnson, with global sales moving toward the billion dollar range, according to Healing Maps.
For agents, the key distinction is that:
Both, however, involve ketamine’s pharmacology and similar clinical risks.
Transcranial magnetic stimulation is a noninvasive neuromodulation technique. A TMS device uses a magnetic coil placed over the scalp to deliver pulses that stimulate targeted brain regions. TMS was cleared by the FDA in 2008 for major depressive disorder that has not responded to at least one antidepressant, and later for obsessive compulsive disorder and other indications.
TMS is delivered as a series of daily sessions, typically five days per week for four to six weeks, followed by taper or maintenance. There is no systemic medication involved, and the most common side effects are scalp discomfort and headache. The most serious known risk is a provoked seizure, which is rare when protocols are followed.
Because TMS has specific FDA indications and a well-defined protocol, payers are more comfortable reimbursing it. A 2025 market outlook from Covenant Health Advisors notes that TMS and Spravato have become mainstream revenue lines for many outpatient psychiatry practices, backed by Medicare and commercial coverage when criteria are met.
For insurers, TMS looks more like other device-based procedures. For agents, it means a growing number of psychiatry clients now operate both office-based therapy and interventional equipment.
Multiple research firms now publish dedicated U.S. ketamine clinic market reports. A 2024 analysis by Grand View Research estimated the U.S. ketamine clinics market at about 3.41 billion dollars in 2023, with a forecast compound annual growth rate of roughly 10.6 percent through 2030. Other analysts such as IMARC Group and Nova One Advisor provide similar figures, with projections that U.S. ketamine clinic revenue could double again by the early 2030s.
On the TMS side, exact U.S. revenue figures are less visible but follow a similar pattern. Device manufacturers and practice development firms report steady double-digit growth in TMS volumes as more clinics install systems and referral patterns mature. A 2025 neuromodulation market article from NeuroMod Health describes TMS and Spravato as two of the most significant growth drivers for outpatient depression treatment.
In plain terms, this is no longer a boutique service. It is a multibillion-dollar treatment segment that is expected to grow faster than the general behavioral health market.
Providers fall into several broad categories.
Each provider type presents a different risk profile for underwriters. Standalone clinics may have leaner infrastructure and shorter track records. Hospital based programs may have more robust governance but also higher claim severity potential.
From an insurance perspective, the growth of ketamine and TMS matters for several reasons.
Ethos Insurance Partners works with retail agents across the country who want to grow in healthcare professional liability (HPL) and related lines. If you have existing behavioral health accounts or you are starting to see ketamine or TMS providers in your territory, you do not need to navigate this alone.
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