CMS will not establish reimbursement coverage for psilocybin-assisted therapy under Medicare or Medicaid by December 31, 2028.

For the government health insurance for people over 65 to pay for psilocybin therapy, three things need to happen: the FDA approves it, someone assigns a billing code, and Medicare decides it's worth the cost. Medicare is skeptical of expensive, therapy-heavy treatments, and this whole process takes years. Even if everything moves fast, you're past 2028.

CMS reimbursement requires: FDA approval (not yet granted), a billing code assignment, a National Coverage Determination process (12–24 months), and resolution of prior authorization disputes. The recent WiSER model disapproval demonstrates congressional and CMS friction over novel therapy coverage. Psilocybin-assisted therapy's session-intensive, therapist-paired delivery model creates additional cost-justification hurdles. Even optimistic FDA approval timelines (2027) leave insufficient runway for full CMS coverage by end of 2028.