Insurance Reimbursement Coding for Psilocybin-Assisted Therapy Sessions

Introduction

The field of psychedelic-assisted therapy is undergoing a transformative shift, with psilocybin—the active compound in “magic mushrooms”—emerging at the forefront. Clinical studies have shown that psilocybin can be highly effective in treating a broad range of mental health conditions, including depression, post-traumatic stress disorder (PTSD), substance use disorders, and end-of-life anxiety.

Yet, one key barrier to mainstream adoption remains: insurance reimbursement. Currently, most access to psilocybin therapy occurs through clinical research settings or within decriminalized local jurisdictions. Patients often pay thousands out-of-pocket, as lack of formal approval by the U.S. Food and Drug Administration (FDA) and classification as a Schedule I substance under the Controlled Substances Act blocks reimbursement by most insurance providers.

Progress is emerging, however. States such as Oregon and Colorado are creating frameworks for legal and regulated psilocybin therapy. Simultaneously, institutions like COMPASS Pathways and the Usona Institute are running FDA-authorized clinical trials to push toward federal approval.

Central to achieving insurance coverage is not only legal approval but also the existence of recognized medical billing codes. Health insurers require that services are assigned CPT (Current Procedural Terminology), ICD-10 (International Classification of Diseases – 10th Revision), or HCPCS (Healthcare Common Procedure Coding System) codes in order to approve and process payment. Without such codes, even eligible treatments cannot be reimbursed. As the regulatory landscape evolves, aligning psilocybin therapy with billing infrastructure is key to expanding access.

This article delves into the current challenges and future potential of billing psilocybin-assisted therapy through insurance, by exploring professional studies, policy initiatives, and coding pathway developments.

Professional and Medical Studies Relevant to Reimbursement Coding

Clinical and policy research over the past decade has strongly validated the clinical efficacy of psilocybin-assisted therapy for a range of treatment-resistant conditions. Findings support the therapy’s potential for conditions that insurance typically does reimburse, using conventional treatments.

For example, a 2020 study published in JAMA Psychiatry by Johns Hopkins showed that two psilocybin doses combined with psychotherapy produced significant reductions in depressive symptoms, with effects lasting over a month. Similarly, COMPASS Pathways’ phase 2b trial found statically significant improvements in treatment-resistant depression outcomes relative to the placebo group.

Despite these promising results, the lack of modern coding structures limits the integration of psychedelic therapy into the broader healthcare reimbursement system. The American Medical Association (AMA), responsible for maintaining CPT code sets, has yet to introduce codes tailored specifically to psychedelic-assisted therapy.

Nevertheless, some professionals have begun adapting existing codes, including:

– CPT Code 90837: 60-minute psychotherapy session
– CPT Code 99499: Unlisted evaluation and management services
– HCPCS Codes G2086–G2088: Originally developed for office-based opioid treatment, but sometimes repurposed in experimental clinic billing

These provisional arrangements remain experimental and do not guarantee reimbursement. They are best understood as temporary workarounds until formal psychedelic-specific codes are developed. Some practices even categorize therapy as part of “integrative health services” to attempt reimbursement under wellness or coaching codes—however, this introduces regulatory and ethical risks.

A roadmap for proper coding is beginning to take form. A pivotal 2022 white paper from the Multidisciplinary Association for Psychedelic Studies (MAPS) outlines structural reforms needed for reimbursable psychedelic therapy. Though originally focused on MDMA, many themes—such as the need for clear treatment protocols, FDA approval, and updated coding—are relevant across the psychedelic space, including for psilocybin.

Encouragingly, in 2023, the Centers for Medicare & Medicaid Services (CMS) began approving codes for certain novel interventions, hinting at a more receptive environment. The move suggests psilocybin therapy may one day be reimbursable — provided it follows the same scientific and regulatory pathways.

It is essential that planners, researchers, and advocacy organizations collaborate to propose new CPT and HCPCS codes for psychedelic-assisted protocols. These should cover the entire care continuum: intake screening, preparatory therapy, supervised dosing, integration therapy, and follow-up care.

Conclusion

Psilocybin-assisted therapy has rapidly gained ground as a promising solution to various treatment-resistant psychiatric conditions. But without a formal billing system in place, access remains limited to privileged settings like research institutions or boutique clinics. The lack of proper CPT, ICD-10, and HCPCS codes is among the most significant barriers impeding broader reimbursement by health insurance providers.

Establishing standard, recognized coding frameworks is key to integrating psilocybin therapy into mainstream medical practice. From intake assessments to therapeutic integration sessions, each stage of care needs aligned coding to ensure proper documentation and insurance claim processing.

The journey toward full coverage will require coordinated advocacy, data-sharing, and engagement with institutions like the AMA and CMS. As these pieces come into alignment, insurance reimbursement may soon become a reality, expanding access to those who need it most—beyond wealth and geography.

References

– Johns Hopkins Medicine (JAMA Psychiatry)
– COMPASS Pathways Clinical Trials
– MAPS Policy and Insurance White Paper
– American Medical Association (AMA)
– Centers for Medicare and Medicaid Services (CMS)

Concise Summary

Psilocybin-assisted therapy shows strong clinical promise for treating depression, PTSD, and substance use disorders. However, lack of insurance reimbursement remains a key barrier due to its current Schedule I status and the absence of suitable CPT, ICD-10, and HCPCS codes. While provisional codes are being used experimentally, formal approval pathways are still pending. States like Oregon are creating legal models for therapy, and federal trials by COMPASS Pathways and MAPS are pushing toward FDA approval. Critical next steps involve codifying psychedelic-assisted procedures into billing systems to ensure reimbursement and broader public access.