AMA's Reimbursement Codes For Psychedelic-Assisted Therapies Take Effect: Here's What To Expect

The American Medical Association’s new coverage and reimbursement codes for FDA-legalized psychedelic-assisted therapies, the current procedural terminology (CPT) III codes, have become active for physicians and other qualified healthcare providers to apply.

These are temporary codes assigned to emerging technologies, services and procedures, to facilitate reimbursement and support access to psychedelic therapies in the U.S. 

The data collected through the use of the new CPT III codes could reflect sufficient usage, and eventually lead to them being converted to permanent CPT I codes, with a valuation assigned for widespread coverage and reimbursement. 

First announced in July 2023, the codes have been jointly championed by the for-profit arm of the legendary Multidisciplinary Association for Psychedelic Studies, MAPS PBC, and biotech COMPASS Pathways CMPS. 

More specifically, AMA accepted the new CPT III codes application in March 2023. Titled "Continuous In-Person Monitoring and Intervention during Psychedelic Medication Therapy," the first code (0820T) is for a healthcare professional to be reimbursed for monitoring and intervention during psychedelic-assisted therapy. Two additional modifiers (codes 0821 and 0822) are for reimbursement for a second qualified healthcare professional and for clinical staff.

Both companies have performed some of the most advanced research on MDMA therapy for PTSD treatment and psilocybin therapy for Treatment-Resistant Depression (TRD,) respectively.

MAPS PBC’s recent application to the FDA for MDMA administration paired with psychological intervention is, essentially, the step prior to having what would be the first federally legal psychedelic-assisted therapy. CEO Amy Emerson says "It is critical that there is a path to cover not only the MDMA but also the medication sessions should this novel investigational approach be approved."

With the Breakthrough Therapy designation given to MDMA in 2017, MAPS PBC has requested the FDA grant Priority Review of the new drug application. The FDA has 60 days to determine whether the NDA will be accepted for review and whether it will be a priority or standard review of six or ten months, respectively. 

If approved by the FDA, the DEA would be required to reschedule MDMA making it available for prescription medical use.

See Also: Groundbreaking Study: LSD Tartrate Reduces Anxiety Effectively, Says MindMed

Photo: Benzinga edit with photo by Unsplash.