Summary & Overview
HCPCS A9291: Prescription Digital Cognitive/Behavioral Therapy, FDA-Cleared
HCPCS Level II code A9291 identifies an FDA-cleared, prescription digital therapeutic that delivers cognitive and/or behavioral therapy per course of treatment. As digital therapeutics expand, this code formalizes billing for prescribed software-based interventions that can be delivered in ambulatory or home settings and supports payer coverage and clinical adoption nationally.
Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage policies vary across commercial plans and Medicare; the presence of a distinct HCPCS Level II code facilitates policy development, prior authorization workflows, and claims processing.
Readers will find a concise overview of what the code represents, typical sites of service, and the clinical context for digital cognitive and behavioral treatment. The publication also covers payer coverage patterns, common modifiers used with the code, and implications for coding workflows and reimbursement administration. Where input data are incomplete, the report notes: "Data not available in the input." The goal is to clarify the purpose of A9291 and provide a practical reference for coding, billing, and policy teams navigating coverage of prescription digital therapeutics.
Billing Code Overview
HCPCS Level II code A9291 describes prescription digital cognitive and/or behavioral therapy, FDA cleared, per course of treatment. This code represents a digitally delivered, prescription-based therapeutic course that delivers cognitive and/or behavioral therapy through an FDA-cleared software or device.
Service Type: Prescription digital cognitive and/or behavioral therapy (digital therapeutic)
Typical Site of Service: Ambulatory/outpatient or home-based digital delivery
Clinical & Coding Specifications
Clinical Context
A 34-year-old patient with a primary care or behavioral health referral presents with moderate major depressive disorder and limited access to in-person psychotherapy. The clinician prescribes an FDA-cleared prescription digital cognitive and/or behavioral therapy course delivered via a regulated software application. The patient completes an initial intake questionnaire and standardized symptom measures (for example, PHQ-9 or GAD-7) within the app. The prescribing clinician documents medical necessity, reviews baseline scores, and initiates the digital therapeutic by issuing a prescription or authorization code tied to the patient’s identity.
The clinical workflow includes: initial evaluation and diagnosis by a licensed clinician; documentation of informed consent and prescription in the medical record; submission of the claim using A9291 for the per-course digital cognitive/behavioral therapy; tracking of patient engagement and periodic symptom reassessments through the application; and clinician follow-up visits or messages to assess response and determine need for additional courses or alternative treatments. Typical sites of service are outpatient primary care offices, behavioral health clinics, telehealth settings, and patient-managed home use via the regulated software platform.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |