The new CPT codes will provide physicians and other qualified healthcare providers a means to seek coverage and reimbursement for delivering psychedelic-assisted therapy if approved by the FDA.
MAPS Public Benefit Corp. announced that the American Medical Association current procedural terminology (CPT) III codes for psychedelic-assisted therapies are now in effect.
First announced in July 2023, the new CPT codes will provide physicians and other qualified healthcare providers a means to seek coverage and reimbursement for delivering psychedelic-assisted therapy if approved by the U.S. Food and Drug Administration.
In December, MAPS PBC submitted a new-drug application to the FDA for MDMA (midomafetamine capsules) used in combination with psychotherapy and other supportive services provided by a qualified healthcare professional. 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 for 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.”
These are temporary codes assigned to emerging technologies, services and procedures to facilitate reimbursement and support access to psychedelic therapies in the United States, if such therapies receive regulatory approval by the FDA.
The new CPT III codes are intended to be used for data collection to substantiate sufficient usage, which could lead to them to be converted to permanent CPT I codes with a valuation assigned for widespread coverage and reimbursement, MAPS PBC noted.
MAPS PBC and COMPASS Pathways collaborated to work with the American Medical Association (AMA) to create the new CPT III codes.
A Uniform Language
CPT codes “offer doctors and healthcare professionals a uniform language for coding medical services and procedures to streamline reporting, increase accuracy and efficiency,” according to the AMA. “CPT codes are also used for administrative management purposes such as claims processing and developing guidelines for medical care review.”
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 healthcare 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, respectively.
With “breakthrough therapy” designation given to MDMA in 2017, MAPS PBC has requested the FDA grant priority review of the new-drug application. The FDA has 60 days to determine whether the application will be accepted for review and whether it will be a priority or standard review (six months or 10 months, respectively).
If approved by the FDA, the U.S. Drug Enforcement Administration would be required to reschedule MDMA, making it available for prescription medical use.
MDMA-assisted therapy has not been approved by any regulatory agency. The safety and efficacy of MDMA-assisted therapy have not been established for the treatment of PTSD.