Although none are yet approved by the FDA, the American Medical Association has approved a Current Procedural Terminology (CPT) code for psychedelic treatments.
CPT codes provide healthcare professionals a means to seek reimbursement for the delivery of FDA-approved medicines. The new code is the result of a joint effort pursued by Compass Pathways ($CMPS) and MAPS Public Benefit Corporation, who are both working on psychedelic-based therapies hoping to gain FDA approval.
Compass Pathways is evaluating a psilocybin therapy for treatment-resistant depression that is currently in phase 3. Experts say the approval of psilocybin could be seen in the next few years, but not likely before 2025.
Peter Thiel-backed company Atai Life Sciences ($ATAI) holds a 20% stake in Compass Pathways. MAPS has already finished two phase 3 trials of MDMA-assisted therapy for post-traumatic stress disorder (PTSD).
Compass officials stated that they decided to seek approval of the code after learning about difficulties experienced with reimbursement for Johnson & Johnson’s esketamine nasal spray (Spravato®), which is already FDA-approved for treatment-resistant depression and requires 2 hours of monitoring after administration.
Providers of Spravato® have faced some difficulties navigating reimbursement for the monitoring period.
The new CPT code is specifically for the time a provider spends with the patient, not the drug itself. AMA’s former CPT director Michael Beebe said the two parts of psychedelic-assisted therapy—the drug and the assisting healthcare professional—are what makes it a different type of treatment modality.
The new code will cover the existing reimbursement gap for psychological support provided during psilocybin therapy sessions which are usually around 6 to 8 hours long. Psychotherapy given before and after treatment, such as preparation and integration sessions, would be covered by existing CPT codes for psychotherapy.
To be clear, reimbursement of the new CPT code will not be mandatory. Payers will look at the published clinical data and decide if it can be replicated in real-world conditions, keeping in mind that it is directed to patients who have not responded to traditional therapies and have limited alternatives.
Ultimately, it will be up to both public and commercial payers to decide whether they want to cover these codes and pay for psychedelic treatments. The approval of these codes by the AMA is certainly a step in the right direction and helps bring psychedelic therapies one step closer to the patients who need them.