When psychedelic therapies begin to gain regulatory approval, they will need to be incorporated into the medical billing and coding system in a way that ensures equitable patient access, say experts.
As increasing evidence from psychedelic research shows their potential as treatments for mental health conditions, states such as Oregon and Alberta have begun regulating for the delivery of psychedelic-assisted therapies, likely with more to follow.
While these are positive developments for patients, a group of experts has highlighted the importance of ensuring affordable access to the therapies for patients.
In this regard, the experts have published an article that presents a robust medical billing and coding strategy in the inaugural issue of Psychedelic Medicine, titled “Psychedelic Medicine’s Future Depends on Proactive Development of a Robust Medical Billing and Coding Strategy”.
Ensuring access for patients
Co-authored by Brian Barnett, from US-based Cleveland Clinic, the authors note that investigational psychedelic therapies are likely to begin gaining regulatory approval as medical treatments in the US within the next two years.
When this happens, however, a number of barriers to equitable patient access will remain – including its incorporation into the United State’s medical billing and coding system, which the authors highlight plays a central role in reimbursement for health care services.
They emphasise that, if approved, equitable patient access will depend on the incorporation of these novel treatments into the medical billing and coding system.
The authors write: “Although still investigational, psychedelic therapies appear poised to begin securing regulatory approval as medical treatments in the United States within the next two years…
“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.”
The authors propose that the development of de novo billing codes is the best approach for addressing psychedelic therapy reimbursement concerns.
Several factors make psychedelic therapy, “particularly vulnerable to development of billing codes that undervalue the complexity of its delivery,” state the authors.
They write: “We argue that development of de novo billing codes in conjunction with the American Medical Association’s Current Procedural Terminology (CPT) Editorial Panel is the best approach for addressing psychedelic therapy reimbursement concerns.
“However, with no similar existing medical services to guide development, the potential need for multiple providers during dosing sessions, limited mental health care representation on the CPT Editorial Panel, and a number of misconceptions surrounding psychedelic therapy among critics, psychedelic therapy is particularly vulnerable to development of billing codes that undervalue the complexity of its delivery.”
An industry-sponsored application for new CPT codes for psychedelic drug monitoring services is soon to be reviewed by the CPT Editorial Panel, say the authors, which they describe as a critical step toward maximising psychedelic therapy’s societal impact.
“Whether these proposed codes ultimately become the bedrock of billing for psychedelic therapy or future codes are developed to augment or replace them is not known, but it is a promising sign that efforts to create a robust medical billing and coding strategy for psychedelic medicine are now underway,” they write.
