Will MDMA Eventually Be Covered By Insurance? AMA Psychedelic-Specific Therapy Codes Start That Journey

The American Medical Association (AMA) implementation of new Current Procedural Terminology (CPT) III codes for psychedelic-assisted therapies has now been taken into effect. These codes are designed to provide coverage and reimbursement for qualified healthcare providers who may deliver these therapies should they receive approval from the U.S. Food and Drug Administration (FDA). One such therapy that has been gaining attention is MDMA-assisted therapy for the treatment of post-traumatic stress disorder (PTSD).

MAPS PBC, now known as Lykos Therapeutics, has a rich history of supporting qualified healthcare providers in delivering investigational MDMA-assisted therapy for individuals with PTSD and other mental health conditions. With years of research and clinical trials, they have been working towards gaining FDA approval for this innovative therapy. The new CPT III codes are an important step forward in achieving that goal.

MDMA-assisted therapy is a form of psychedelic therapy where MDMA is used in conjunction with psychotherapy to treat mental health conditions like PTSD. This treatment has shown promising results in clinical trials and could potentially provide relief for those who have not responded well to traditional treatments.

These new CPT III codes hold immense significance for the future use of psychedelic therapies, particularly MDMA-assisted therapy. They provide a clear path for coverage and reimbursement, making it more accessible to patients in need. These codes not only cover the cost of the medication itself but also the necessary therapy sessions that are crucial for successful treatment, per a press release from Lykos Therapeutics. This is a major step towards integrating these therapies into mainstream medicine.

Creation of the CPT III Codes

The creation of these new CPT III codes was a collaborative effort between two leading organizations, Lykos Therapeutics and COMPASS Pathways. Working together, they submitted an application to the AMA for consideration. After thorough review and acceptance, these codes are now in effect, providing a path for coverage and reimbursement for qualified healthcare providers.

“In December 2023, MAPS PBC (now Lykos Therapeutics) submitted a new drug application (“NDA”) to the FDA for MDMA (midomafetamine capsules) used in combination with psychological intervention, which includes psychotherapy, or talk therapy, and other supportive services provided by a qualified healthcare provider. Investigational MDMA-assisted therapy is in development for individuals with post-traumatic stress disorder (“PTSD”).”

“Having recently filed a new drug application for MDMA-assisted therapy for PTSD, these new CPT codes are an important step forward to pave the way for its future use should it be approved by the FDA,” said Amy Emerson, chief executive officer, MAPS PBC. “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.”

On March 3, 2023, the AMA published the Summary of Panel Actions which included the acceptance of the new CPT III codes. The application was titled, “Continuous In-Person Monitoring and Intervention during Psychedelic Medication Therapy.” The first code (0820T) is for a health care professional to be reimbursed for monitoring and intervention during psychedelic-assisted therapy. There are two additional modifiers (code 0821 and 0822) that are for reimbursement for a second qualified healthcare professional and for clinical staff.

These new CPT III codes truly pave the way for the potential approval of MDMA-assisted therapy by the FDA. With these codes in place, data can be collected on their usage and effectiveness, providing evidence to support a conversion to permanent CPT I codes. This would allow for widespread coverage and reimbursement from insurance companies.

The FDA has until mid-February to decide whether to accept the NDA for MDMA, and if approved, it would be a groundbreaking moment in history. MDMA would become the first psychedelic to receive approval as a pharmaceutical and be administered alongside psychotherapy and other supportive services. This would not only provide hope for individuals suffering from PTSD but also open doors for further research and potential approvals of other psychedelic therapies.

It is important to note that insurance coverage for these treatments would greatly increase accessibility and affordability for patients in need. Many individuals with PTSD have struggled to find effective treatment options, and MDMA-assisted therapy could be life-changing for them. With the support of these new CPT III codes, this potential treatment option may soon become a reality for those who are suffering.

Overall, the creation and implementation of these new CPT III codes is a major step towards the integration of psychedelic therapies into mainstream medicine, bringing hope and healing to those in need. So while we wait for the FDA’s decision, we can be hopeful that these codes will pave the way for a brighter future for individuals with PTSD and other mental conditions!

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