A few months back, Dr. Rayna, a psychiatrist in Denver, treated a combat veteran with complex PTSD using psilocybin-assisted therapy. After just a few sessions, he finally said:
“I feel like I can sleep again. Like my brain’s not trying to kill me.”
The problem?
His insurance denied coverage. Again. They called it “investigational.”
He ended up paying over $5,000 out of pocket—for care that worked when nothing else did.
This is the harsh reality facing providers and patients in 2025:
We have powerful new treatments... but no map for how to pay for them.
⚙️ 5 Things You Can Do Today to Stop Bleeding Cash Offering Psychedelic Care
1. Understand CPT-III Codes — and Their Limits
Category III codes like 0791T for psychedelic therapy exist—but they’re not inherently reimbursable. Make them count by:
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Pairing them with standard psychotherapy CPT codes like 90837
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Including diagnosis codes (e.g., F33.2 for major depressive disorder)
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Documenting distinct phases: preparation, dosing, and integration
2. Track Outcomes Like Your Payments Depend on It (Because They Do)
Use PHQ-9, GAD-7, and PCL-5 scores consistently. They:
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Prove value in appeals
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Show efficacy to employers and payers
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Offer the foundation for pilot coverage programs
3. Don’t Wait for FDA Approval
Spravato got coverage before MDMA or psilocybin saw FDA approval. You don’t need full approval—just clinical structure, safety documentation, and evidence.
4. Pitch Direct to Employers
Platforms like Enthea are already working with HR departments to cover psychedelic treatment as part of mental health benefits. Build case studies. Propose discounted group rates. Offer data-sharing dashboards in exchange for funding.
5. Partner with a Pharmacist
Collaborate with a licensed pharmacist to manage REMS protocols and drug interactions. It adds clinical credibility and opens the door for pharmacy benefit reimbursement.
🧠 What the Experts Are Actually Saying
🧪 “Pharmacists are key. REMS oversight gives you a legit seat at the payer’s table.”
— Dr. Sa’ed Al-Olimat, PharmD, Co-Founder of Remedy
📈 “We’re in a policy vacuum. Use that to define best practices with actual data.”
— Molly Candon, PhD, Health Economist, University of Pennsylvania
🕐 “A single MDMA session can take 6 hours. Our system isn’t designed for that—yet.”
— Rajeev Ramchand, PhD, Senior Behavioral Scientist, RAND Corporation
🤯 Bad Advice You Should Stop Following
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“Just wait for insurance to catch up.” → You’ll be waiting years. Build around employer coverage now.
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“You can’t bill for integration.” → Not true. You can use standard psychotherapy codes if documented clearly.
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“Outcomes only matter for research.” → No, outcomes drive reimbursement today.
😬 Lessons From My Own Mistakes
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I submitted Category III codes alone—denied.
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I didn’t document integration sessions—insurers flagged them as “unsupported.”
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I didn’t track outcomes early on. That cost me leverage during pilot negotiations.
❓ FAQs – Because We All Have the Same Questions
Q: Can I bill for psychedelic therapy yet?
A: For ketamine and Spravato, yes—with proper structure. Psilocybin and MDMA? Not yet FDA-approved, but employer coverage and experimental protocols are emerging.
Q: Can I bill prep and integration sessions?
A: Yes. Use psychotherapy CPT codes like 90834/90837 and clearly link to the mental health diagnosis.
Q: Should I bother appealing denied claims?
A: Absolutely. Use outcome metrics, attach peer-reviewed studies, and get help from a medical biller who knows the space.
📚 This Week’s Must-Read Sources
🗞 Will Health Insurance Cover Psychedelic Therapy?
A breakdown of current employer-sponsored options and public insurance gaps.
🔗 Psychedelic Passage
🔗 Petrie-Flom Center, Harvard
🔗 The Bluntness
🧠 The FDA Didn’t Approve MDMA—What Now?
Explores the gap between clinical results and FDA resistance.
🔗 TIME Magazine
🔗 Forbes
🔗 Slate
📊 Spring 2025 Psychedelic Policy Update
An overview of state-level progress on legalization and insurance alignment.
🔗 Psychedelic Alpha
🔗 PsyNews
🔗 Reason Foundation
💬 Final Word: Get Involved — Now
This isn't just about reimbursement codes. This is a chance to reshape mental health care. You can wait on broken systems—or help build better ones. 🛠
Get involved.
Lend your voice.
Raise your hand.
Support the mission.
Step into the conversation.
Take the first step.
Let’s build the future—together.
P.S. This blog is for every provider who’s ever felt forced to choose between healing and sustainability. There’s a better way—and we’re creating it now. 🔥
→ #PsychedelicTherapy #KetamineCare #MDMATreatment #BillingReform #MentalHealthInnovation #CPTIII #EmployerCoverage #OutcomesMatter #BreakTheStigma #PsychedelicMedicine #Let’sDoThis #ReimbursementStrategy #ValueBasedCare
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