CMS Sets New Reimbursement Code For FDA-Approved Prescription Digital Behavioral Therapeutics

On April 1, 2022, the Centers for Medicare & Medicaid Services (CMS) went live with a new reimbursement code for prescription digital behavioral therapeutics (PDTs) that have been cleared by the Food and Drug Administration (FDA). The new Healthcare Common Procedure Coding System (HCPCS) code, Level II, is A9291. It can be used for a course of treatment with any PDTs cleared by the FDA. The code gives payers the option to reimburse for PDTs through either pharmacy or medical benefits.

CMS released the new code in February 2022 in “Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure . . .