Federal Government Facilitates Access To Prescription Digital Behavioral Therapies

CMS Establishes Standardized Code for Insurers To Process Claims for Payment

WASHINGTON, March 23, 2022 /PRNewswire/ -- Today, Aimed Alliance, the Center for U.S. Policy and the International Health Facility Diversion Association commended the federal government for facilitating patient access to prescription digital behavioral therapies. The Centers for Medicare & Medicaid Services (CMS) will establish a new medical code, effective April 1, 2022. The new Healthcare Common Procedure Coding System (HCPCS) Level II code, A9291, is intended to help health insurers provide access to digital behavioral therapies in the home setting. 

The Food & Drug Administration (FDA) has cleared a game-based digital therapeutic to improve attention in children with attention deficit hyperactivity disorder (ADHD). The agency has cleared mobile apps to help treat substance use disorders, to help increase retention in outpatient treatment for individuals with opioid use disorder, and for treating adults with chronic insomnia.

HCPCS Level II is a standard, national medical code system Medicare and other health insurance programs use to ensure that health care payment claims are processed in an orderly and consistent manner. HCPCS Level II is used primarily to identify items, supplies, and services not included in the American Medical Association's Current Procedural Terminology (CPT) coding system when used outside a health care provider's office.

"CMS believes that establishing a code at this time may facilitate options for non-Medicare payers to provide access to this therapy in the home setting," the agency stated in its February 2022 coding decision.

In December 2021, Aimed Alliance, which leads a working group to advance patient access to evidence-based digital therapies, supported a third-party request for CMS to issue a HCPCS Level II code for FDA-cleared digital therapeutics.

"Access to a variety of in-person and remote treatment options is essential to ensure patients can conveniently obtain the health care they need," Eifer Lyddane, Aimed Alliance Board Member, stated.

"CMS's decision will facilitate payment for FDA-cleared digital behavioral therapies, expand access to individually appropriate treatment, and improve public health," Ms. Lyddane said.

In December 2021, the Center for U.S. Policy (CUSP), a member of the Aimed Alliance working group, urged the federal Interdepartmental Substance Use Disorders Coordinating Committee to provide federal coding for FDA-cleared digital therapies to help address the mental health, substance use disorder, and drug poisoning crises.

"We thank CMS for acting with speed to expand access to evidence-based digital therapies for behavioral health," Michael Barnes, Chairman of CUSP, said.

Marsha Stanton, Ph.D., R.N., President of the International Health Facility Diversion Association, which is also a working group member, said, "We applaud the federal government for facilitating the use of digital therapies and monitoring programs. Anything that we can do to improve interactions and support trust-based relationships between patients and their clinicians is a step in the right direction."

About Aimed Alliance

Aimed Alliance is a not-for-profit health policy organization that works to protect and enhance the rights of health care consumers and providers. Aimed Alliance leads a multidisciplinary stakeholder group that seeks to expand patient access to evidence-based digital therapies. For more information on Aimed Alliance and its initiatives, go to aimedalliance.org and follow @aimedalliance on Twitter.

About the Center for U.S. Policy (CUSP)

CUSP is a nonpartisan, 501(c)(3) not-for-profit research and education organization. CUSP's 2022 issue priorities include reducing substance use disorders and their consequences, including drug poisonings. For more information on CUSP and its initiatives, go to centerforuspolicy.org and follow @USPolicyCenter on Twitter.

About the International Health Facility Diversion Association (IHFDA)
IHFDA is an international network of professionals devoted to protecting patients, staff, and facilities from the harms associated with drug diversion and substance misuse by healthcare personnel. For more information on IHFDA, go to ihfda.org and follow @ihfda_org on Twitter.

SOURCE Center for U.S. Policy