COMPASS Pathways and MAPS Public Benefit Corporation (PBC) have put forward a joint application for a new code to facilitate access to psychedelic therapies in the US if they receive FDA approval.
The current increase in clinical research into the use of psychedelics for mental health indications is showing the compounds as potentially efficacious treatments.
This promising evidence may lead to the regulatory approval of psychedelic-assisted psychotherapies in the near future. However, when psychedelic therapies do begin to gain regulatory approval, they will need to be incorporated into America’s medical billing and coding system to ensure equitable access for patients.
A group of experts recently published an article in the inaugural issue of Psychedelic Medicine, highlighting that, “Since specific billing codes for psychedelic therapy delivery do not exist, modification of existing codes or development of de novo codes will be necessary. This reality has created uncertainty about reimbursement and the financial future of psychedelic medicine.”
UK-based COMPASS Pathways plc, which is currently carrying out the first Phase 3 clinical trial of its kind for psilocybin-assisted psychotherapy in treatment-resistant depression, and MAPS Public Benefit Corporation (MAPS PBC), which has completed two Phase 3 clinical trials evaluating MDMA-assisted therapy as a potential treatment for post-traumatic stress disorder (PTSD), recently announced that the American Medical Association (AMA) has approved a Current Procedural Terminology (CPT) III code for psychedelic therapies.
CPT III codes are a set of temporary codes assigned to emerging technologies, services and procedures. They are intended to be used for data collection to substantiate more widespread usage or to provide documentation for the FDA approval process.
The application for the new code was the result of a collaboration between MAPS PBC and COMPASS Pathways to facilitate reimbursement and access to psychedelic therapies in the US.
The companies emphasise that this new code may provide a mechanism by which these new treatments being developed by COMPASS and MAPS PBC could be reimbursed if they are approved by the FDA.
CEO of COMPASS Pathways, Kabir Nath, stated: “This is a major step forward to enabling broad and equitable access to psychedelic therapies.
“This collaboration with MAPS PBC to develop a new CPT code aims to ensure that psychedelic therapies, if approved, could be integrated into healthcare systems, reimbursed by payers, and made available to the people who need them.”
“Psychedelic-assisted therapies represent a potential new frontier in the treatment of mental health conditions and our top priority is ensuring there is a path forward to integrate them into the healthcare system, if FDA approved,” added Amy Emerson, CEO of MAPS PBC.
“Strong collaborations like this one demonstrate that by working together, we can move closer to our collective goal of helping people currently underserved by existing treatments for mental health conditions.”
The full details of the code are expected to be released by the AMA in July 2023 and the code will go into effect when it is published on January 1, 2024.
Once effective, the CPT code will provide physicians and other qualified healthcare professionals a means to code and seek reimbursement for delivering psychedelic therapies.
