Decoding Insurance Reimbursement For Psychedelic-Assisted Therapy With BrainFutures Guide

In the midst of an expected FDA approval of MDMA-assisted therapy in 2024, BrainFutures has released a comprehensive guide for practitioners offering psychedelic-assisted therapy (PAT.)  BrainFutures is a national nonprofit that assesses and advances the practical application of neuroscience research.

The estimated cost of each treatment protocol (including a single administration session) is thousands of dollars, up to $11,000. Thus, without billing mechanisms that enable coverage, including medical codes, the therapy option will be limited to those who can afford to pay out-of-pocket, thereby reinforcing existing inequities in mental healthcare and denying access to those who could benefit from it.  

Result of a joint experts workgroup effort, the new CPT and HCPCS Codes guide aims to help make PAT affordable and accessible through health insurance, once approved by the federal agency, by providing a unified roadmap to medical coding and third-party billing. 

“Psychedelic-assisted therapy is a promising treatment for those suffering from difficult-to-treat mental health and substance use disorders. However, for psychedelic-assisted therapy to make a difference, we must ensure it is accessible to all who stand to benefit from it,” said executive director David Esselman. 

Esselman trusts the coding guide will bring those involved “one step closer” to ensuring those who need PAT can afford it regardless of their socioeconomic status. 

Workgroup member psychiatrist Dr. Carlene MacMillan added that integrating PAT into mainstream mental healthcare requires “a comprehensive understanding of how to code for this treatment,” after which practitioners will be able to advocate for their patients “and secure the reimbursement they deserve.”

For his part, member and psychologist Dr. Brian Richards envisions a future where insured patients are responsible for a $20 co-payment for the therapy. 

BrainFutures has developed several issue briefs toward advancing the PAT field since 2021 and is currently working with stakeholders to help lay the needed regulatory and reimbursement work foundation. (See the recently published Professional PAT Practice Guidelines)

Photo: Benzinga edit with photo by Vlada Karpovich on Pexels and Ground Picture on Shutterstock and Wikipedia.