Billing is optional and runs on top of the record. Screening, prep, and integration sessions bill like regular therapy under Medicaid and private insurance today. The dosing day itself can't be billed until the FDA approves the medicine.
Prep sessions, dosing days, and integration visits all bill differently, and some of it can't go to insurance at all. We code to the legal guidance written for psilocybin therapy in New Mexico, and we can show our work on every claim.
Most clinicians in this field have never been in-network with an insurance company. Getting approved — credentialing — takes months of forms and follow-up calls, so we start before your doors open. You send us one packet of documents and we take it from there: Medicaid enrollment, CAQH, plan applications, contracting.
Someone at your front desk uploads visit records to our portal. We check each patient's coverage, tell you in plain English if anything is missing, send the claims to the insurance company, track the payments, and follow up on anything that gets denied.
The software drafts claims. It doesn't send them. A billing specialist looks at every claim, prior authorization, and appeal before it goes anywhere, and the system flatly refuses to bill things that shouldn't be billed.
| Payer | Screening | Prep session (×2) | Integration session (×2, 60 min) | Insurance pays* |
|---|---|---|---|---|
| NM Medicaid (Turquoise Care) | $133 | $228 | $218 | $1,027 |
| BCBS New Mexico | $145 | $213 | $152 | $876 |
| Presbyterian Health Plan | $138 | $203 | $148 | $840 |
* One screening, two prep sessions, and two 60-minute integration sessions, billed with standard E/M and psychotherapy codes. These are provisional fee-schedule rates for illustration. Your actual rates get set in your payer contracts during credentialing. NM Medicaid figures reflect the state's 150%-of-Medicare minimum that took effect January 2025. The dosing day itself, administration and monitoring both, can't be billed to insurance before FDA approval. We route it to self-pay or the state Equity Fund and track it so it never ends up on a claim. If approval comes and coverage opens, turning monitoring billing on is a settings change, worth another $796 to $887 per dosing day at these rates.
Insurance revenue stacks on top of your cash model. Dosing days stay direct pay, and everything around them gets billed. Three credentialed clinicians doing twelve courses a month bring in roughly $10,000 to $12,000 a month that a cash-only clinic never sees, and it grows as more of your clinicians get approved by more plans. You pay a flat credentialing fee up front, then a percentage of what we actually collect.
Screening, prep, and integration go through the insurance a patient already has, Medicaid or commercial, the same way regular therapy does. They pay their normal copays. The dosing day is the one direct cost, and they know the exact amount before their first visit. And for anything paid out of pocket, we provide a coded superbill so patients can seek out-of-network reimbursement from their own plan.
Not sold on insurance? Plenty of practices aren't. We prepare coded superbills instead: your patients file with their own plan for out-of-network reimbursement, and you never sign a payer contract.
Yes. A practice that does not want to join insurance networks can hand patients a superbill — a receipt with the correct insurance codes — for screening, prep, and integration visits. Patients send it to their own plan and ask to be paid back. Downstream prepares the superbill. No credentialing, no claims, no insurance contracts.
In Colorado, intake and psychotherapy under a clinician's own license bill as ordinary psychotherapy; natural medicine services themselves never go to a payer, and the record keeps the two apart so that line never blurs. In Oregon, facilitation sits outside insurance; clinicians providing preparation and integration under their own license can talk to us about billing and superbills. New Mexico billing launches in December 2026.
Yes. An FDA-approved psychedelic medicine runs as ordinary medical care: charted on the clinical side of the record and billed through insurance like any other treatment, with prior authorizations and claims handled the same way. A practice offering both a state program and an FDA route keeps each in its lane in one system — the program record for the state, the clinical record for the payer. In New Mexico, if FDA approval opens coverage for the dosing day, turning that billing on is a settings change.
Record system pricing is set per practice on an initial call. Billing is priced separately: a flat credentialing fee up front, then a percentage of what Downstream collects. A practice that uses only the record system pays no billing fees. Book a call to get a quote.
Pick a time that works, tell us where you practice and what you're interested in — record system, billing, superbills — and we'll take it from there.
Book a call