The American Medical Association detailed a new set of codes for psychedelic medication therapy, marking an important step in securing insurance coverage for these emerging treatments and integrating psychedelic therapies into mainstream medical practices.
The new CPT Category III code, an indicator of a procedure’s medical significance and complexity, mostly pertains to continuous in-person monitoring and intervention during psychedelic medication therapy. It was approved in May after Compass Pathways (Nasdaq: CMPS) and the MAPS Public Benefit Corp. applied for its creation.
MAPS, or the Multidisciplinary Association for Psychedelics Studies, is a nonprofit that has pushed for more research on psychedelic drugs since 1986.
Support for the initiative came from the American Psychiatric Association, American Psychological Association, and the National Association of Social Workers.
Once in effect, these codes will allow physicians and other qualified health care professionals to seek coverage and reimbursement for providing psychedelic-assisted therapy, subject to approval by the U.S. Food and Drug Administration.
Pending FDA approval, the code is expected to include Compass’ COMP360 psilocybin treatment, currently in late-stage development for treatment-resistant depression, as well as MAPS’ MDMA for post-traumatic stress disorder.
“The development of these new codes highlights the potential role in mental health care that MDMA-assisted therapy may play in the future if approved by the FDA,” MAPS PBC CEO Amy Emerson said in a statement Wednesday.
“Given mental health treatments have historically not been reimbursed adequately, it is great to see a new potential avenue for insurance coverage and reimbursement.”
The code could cover multiple psychedelic compounds with psychological support models. It also extends to variable staffing structures and qualified healthcare professionals. A sub-code is provided for non-QHP clinical staff involvement.
Securing a CPT III code is an essential step towards achieving the final goal of receiving permanent and valued Category I codes for psychedelic therapies. The latter is crucial for securing insurance coverage for these treatments.
“This new 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,” said Kabir Nath, CEO of Compass Pathways.
“The language released by the AMA shows that the CPT code will facilitate accurate tracking of the work required to support effective, regulated and reimbursed delivery of these new potential treatments.”
The code will go into effect on Jan. 1, 2024.