September 25, 2023 – In an effort to make psychedelic-assisted therapy affordable and accessible once it is approved by the U.S. Food and Drug Administration, BrainFutures announces the release of their latest issue brief, A Guide to CPT and HCPCS Codes for Psychedelic-Assisted Therapy. This guide aims to provide practitioners with a comprehensive resource to navigate the complex landscape of medical coding and third-party billing for psychedelic-assisted therapy.
As potential clinical access to psychedelic-assisted therapy draws closer with the anticipated approval of MDMA-assisted therapy in 2024, it is imperative to ensure that patients will have affordable access to this treatment through their health insurance. It is currently estimated that the cost of MDMA-assisted therapy could reach upwards of $11,000 for each treatment protocol, including one medication administration session. Without billing mechanisms that enable coverage—including medical codes—psychedelic-assisted therapy will be limited to those who can afford to pay out of pocket, which would reinforce existing inequities in mental healthcare and deny access for many who could benefit from it.
This guide is a key tool that will enable practitioners to bill third-party payers for the professional services provided in psychedelic-assisted therapy. To inform the creation of this coding guide, BrainFutures convened a workgroup of experts in psychedelic-assisted therapy, behavioral health, and coding and billing.
David Esselman, Executive Director of BrainFutures, states “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. This coding guide brings us one step closer to ensuring that those who need psychedelic-assisted therapy can afford it, regardless of their socioeconomic status.” Likewise, Dr. Brian Richards, psychologist, and workgroup member is hopeful for a future where insured patients are responsible for just a twenty-dollar copayment to receive psychedelic-assisted therapy.
Dr. Carlene MacMillan, psychiatrist, and workgroup member states, “The integration of psychedelic-assisted therapy into mainstream mental healthcare necessitates a comprehensive understanding of how to code for this treatment. By providing psychedelic-assisted therapy practitioners with the tools to navigate insurance processes effectively, we are empowering them to advocate for their patients and secure the reimbursement they deserve.”
BrainFutures began their psychedelic-assisted therapy initiative in 2021 and has since released a series of issue briefs focused on advancing the field. Currently, BrainFutures is working with stakeholders to help lay a foundation for the regulatory and reimbursement work needed in the psychedelic-assisted therapy field.
BrainFutures is grateful to the Steven & Alexandra Cohen Foundation, the Darla Moore Foundation, the Cammack Family Charitable Gift Fund, and an anonymous donor for making this project possible.
BrainFutures is a national nonprofit organization dedicated to assessing and advancing the practical application of neuroscience research to maximize human potential. Since 2015, BrainFutures has provided rigorous analyses of new brain health research to share how advances can positively affect all areas of life. To learn more about BrainFutures, please visit www.brainfutures.org.