Can Psychedelics Therapy Be Reimbursed? AMA Releases Details On Coding These Procedures

The American Medical Association (AMA) published language concerning the recently-approved Current Procedural Terminology (CPT) III codes applying to psychedelic-assisted therapies, as announced by its forwarders the MAPS Public Benefit Corporation and COMPASS Pathways CMPS.

These consist of a set of temporary codes assigned to emerging technologies, services and procedures toward facilitating reimbursement and support access to psychedelic therapies in the U.S., if federally approved. 

The new CPT III codes are intended to be used for data collection to substantiate sufficient usage, which could lead to them becoming permanent CPT I codes, with a valuation assigned for widespread coverage and reimbursement.
The approval last March of the new category CPT III code, of which applicants were MAPS PBC and COMPASS jointly, received support from the American Psychiatric Association, American Psychological Association and the National Association of Social Workers.

MAPS PBC’s CEO Amy Emerson said the development of these codes highlights the potential role in mental healthcare that MDMA-assisted therapy may play in the future if approved by the FDA. 

"Given mental health treatments have historically not been reimbursed adequately, it is great to see a new potential avenue for insurance coverage and reimbursement," said Emerson.

COMPASS’ CEO Kabir Nath echoed the sentiment, stating the CPT III code will “help ensure broad and equitable access” to psychedelic therapies if approved for people “who urgently need new options to treat their mental health conditions.” 

Nath added that the language released by the AMA shows “the CPT code will facilitate accurate tracking of the work required to support effective, regulated and reimbursed delivery of these new potential treatments.”

The codes are expected to become effective once published in the CPT manual, on January 1, 2024. They will then provide qualified healthcare professionals a means to seek coverage and reimbursement for delivering “continuous in-person monitoring and intervention during psychedelic medication therapy,” involving MDMA for PTSD treatment first and psilocybin for TRD treatment following suit once approved by the FDA.

While the first code (0820T) is for healthcare professionals, two additional modifiers (codes 0821 and 0822) seek to reimburse qualified healthcare professionals and clinical staff. 

COMPASS will hold a webinar on the new code on Tuesday, July 11 at 8 am ET. 

Greenbrook NeuroHealth Centers CMO Dr. Geoffrey Grammer, Johns Hopkins HealthCare CMO Dr. Marketa Wills, COMPASS’ CEO Kabir Nath and senior VP of patient access and medical affairs Dr. Steve Levine will discuss the codes' impact on healthcare delivery professionals and payers and their role in establishing commercial models for psychedelic treatment following regulatory approval.

Photo: Benzinga edit with photo by Flametric, aiyoshi597, Gisele Yashar, Bacsica and Freedomz on Shutterstock.