CPT III Codes for Psychedelic-Assisted Therapies Take Effect
The American Medical Association’s (AMA) current procedural terminology (CPT) III codes for psychedelic-assisted therapies, which were announced in July 2023, officially went into effect this week, allowing physicians and other qualified healthcare providers a means to seek coverage and reimbursement for the delivery of such services, pending their approval by the US Food and Drug Administration (FDA).
In December 2023, MAPS Public Benefit Corporation (MAPS PBC) submitted a new drug application (NDA) to the FDA for MDMA-assisted therapy for the treatment of post-traumatic stress disorder (PTSD). The filing was the first NDA to the FDA for any psychedelic-assisted therapy.
The enactment of CPT III codes for psychedelic-assisted therapies is a welcome development for MAPS PBC, CEO Amy Emerson said in a news release.
“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,” Emerson said. “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.”
The new CPT III codes are a temporary measure assigned to emerging technologies, services, and procedures. They intended to be used for data collection to provide evidence of sufficient usage, which could lead to the codes being converted to permanent CPT I codes with a valuation assigned for widespread coverage and reimbursement.
The codes were collaboratively developed by the AMA, MAPS PBC, and COMPASS Pathways. The result of the organizations’ work was the CPT III code 0820T, which allows for a healthcare professional to be reimbursed for monitoring and intervention during psychedelic-assisted therapy, along with modifier codes 0821 and 0822, which address reimbursement for a second qualified healthcare professional and for clinical staff, respectively.
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