HCPCS A9292: Prescription Digital Visual Therapy, Software-Only - OpenPayer

Summary & Overview

HCPCS A9292: Prescription Digital Visual Therapy, Software-Only

HCPCS Level II code A9292 represents a prescription digital visual therapy application that is software-only and FDA cleared, billed per course of treatment. As digital therapeutics expand across clinical specialties, this code standardizes reporting for a non-device, software-based vision therapy delivered over a defined treatment course. Nationally, adoption of software-based prescriptions affects coverage policies, prior authorization practices, and alignment with telehealth and digital health frameworks.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of what the code signifies, common billing considerations, and the payer landscape. The publication outlines benchmarks and typical sites of service, summarizes clinical context for prescription digital visual therapy, and highlights policy topics payers and providers are likely to address when integrating FDA-cleared therapeutic software into care pathways.

This resource is intended for billing managers, payers, clinicians, and health policy stakeholders seeking concise, national-level context about HCPCS Level II code A9292, how it is used to report software-only visual therapy per course of treatment, and the policy and operational issues relevant to its uptake.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA9292HCPCS Level IIdigital therapeuticsvisual therapysoftware-onlyprescription digital healthoutpatient therapytelehealth integration

Billing Code Overview

HCPCS Level II code A9292 describes prescription digital visual therapy, software-only, FDA cleared, per course of treatment. This service represents a prescribed software-based therapeutic intervention intended to treat visual conditions through a defined course of therapy.

Service type: Prescription digital visual therapy (software-only)
Typical site of service: Outpatient or home-based digital therapy delivered via patient-owned or provider-provided devices; software is prescribed and accessed remotely or in clinic settings

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adolescent or adult with convergence insufficiency, accommodative dysfunction, or binocular vision disorders who is prescribed an FDA-cleared, software-only, prescription digital visual therapy program for a defined course of treatment. The patient has an evaluation by an optometrist or ophthalmologist documenting symptoms (e.g., diplopia, eye strain, difficulty reading) and baseline clinical measures (near point of convergence, positive fusional vergence, accommodative amplitude). The clinician documents medical necessity, selects the appropriate digital therapy regimen, issues a prescription for the software-only product billed as A9292 per course of treatment, and provides instructions for home or supervised use.

The clinical workflow: the provider performs a diagnostic eye examination, documents the binocular vision diagnosis and treatment plan, prescribes the FDA-cleared software program, and arranges patient access (license key or portal enrollment). The patient completes the prescribed sessions (often daily or several times weekly) over the specified course; progress is monitored by follow-up visits or remote data review. Billing for the software-only prescription uses A9292 once per course of therapy; professional services (evaluation, follow-up) are billed separately using appropriate evaluation and management or ophthalmology/optometry codes and may include modifier 26 when only the professional component is billed or one of the modifiers related to multiple practitioners or technical component responsibilities where applicable.

Coding Specifications

Modifier	Description

HCPCS Level II A9571: Indium-111 Autologous Platelet Diagnostic Study

HCPCS-A9588-FLUCICLOVINE-F18-PET-IMAGING-AGENT-1-MILLICURIE

HCPCS A9588: Fluciclovine F-18, Diagnostic PET Imaging Agent, 1 mCi

HCPCS-A9545-IODINE-I-131-TOSITUMOMAB-THERAPEUTIC-DOSE

HCPCS Level II A9545: Iodine I-131 Tositumomab, Therapeutic Dose

HCPCS-A9275-HOME-GLUCOSE-DISPOSABLE-MONITOR-WITH-TEST-STRIPS

HCPCS A9275: Home Glucose Disposable Monitor, Includes Test Strips

HCPCS-A9606-RADIUM-RA-223-THERAPEUTIC-PER-MICROCURIE

HCPCS A9606: Radium ra-223 dichloride, therapeutic, per microcurie

HCPCS-A9563-SODIUM-PHOSPHATE-P32-THERAPEUTIC-PER-MILLICURIE

HCPCS A9563: Sodium Phosphate P-32 Therapeutic, Per Millicurie

HCPCS-A9515-CHOLINE-C11-PET-DIAGNOSTIC-STUDY-DOSE

HCPCS A9515: Choline C-11 Diagnostic PET Study Dose

HCPCS-A9583-GADOFOSVESET-INJECTION-1ML

HCPCS Level II A9583: Injection, Gadofosveset Trisodium, 1 ml

HCPCS-A9505-THALLIUM-TL-201-DIAGNOSTIC-RADIOPHARMACEUTICAL

HCPCS A9505: Thallium Tl-201 Thallous Chloride, Diagnostic, per mCi

HCPCS-A9274-DISPOSABLE-AMBULATORY-INSULIN-DELIVERY-SYSTEM

HCPCS A9274: External Ambulatory Disposable Insulin Delivery System

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Taxonomy Code	Specialty	Notes
`152W00000X`	Ophthalmology	Providers who diagnose binocular vision disorders and prescribe digital visual therapy.
`152V00000X`	Optometry	Common prescribers and monitors of vision therapy programs.
`261QC1500X`	Pediatric Ophthalmology	Pediatric specialists managing convergence insufficiency and prescribing age-appropriate digital therapy.
`207S00000X`	Occupational Therapist	OTs involved in vision rehabilitation who may supervise or incorporate software therapy into a broader rehab plan.
`207L00000X`	Physical Therapist	PTs with vestibular/visual rehab focus who may coordinate care and monitor functional outcomes.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H51.1`	Convergence insufficiency	Primary indication for prescription digital visual therapy to improve near point convergence and binocular function.
`H52.4`	Presbyopia	May be addressed adjunctively when accommodative support is part of the therapy program for near-vision tasks.
`H52.8`	Other disorders of refraction and accommodation	Includes accommodative dysfunctions that can be treated with digital vision therapy exercises.
`H51.2`	Diplopia	Symptom that may be reduced by targeted binocular vision rehabilitation delivered via software therapy.
`H53.8`	Other visual disturbances	Used for visual symptoms like eyestrain or difficulty reading when directed therapy is prescribed.
`H49.8`	Other specified paralytic strabismus	In selected cases of nonparalytic or partially paralytic strabismus where vision therapy is indicated to improve binocular control.
`H52.5`	Amblyopia, unspecified	Adjunctive digital therapy may be used in some amblyopia treatment regimens, particularly in pediatric patients.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`92004`	Comprehensive ophthalmological service, new patient; intermediate, with initiation of diagnostic and treatment program	Used for initial diagnostic evaluation when a new patient is assessed and a prescription for digital visual therapy is issued.
`92014`	Ophthalmological service, established patient; intermediate, with initiation or continuation of diagnostic and treatment program	Used for established patient follow-up visits to monitor response to the software therapy and adjust the course.
`92083`	Visual field examination, extended (e.g., automated static perimetry), quantitative, with interpretation and report	May be used when objective visual function testing is performed as part of baseline or follow-up assessment in complex cases.
`95920`	Electronystagmography, without recording, with interpretation and report	Applicable when vestibular or eye movement testing is performed in conjunction with vision therapy assessment (select cases).
`97112`	Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation	Used when supervised, hands-on vision rehabilitation exercises are provided in conjunction with the software program.
`99091`	Collection and interpretation of physiologic data digitally stored and/or transmitted by the patient and/or caregiver	Used when clinicians bill for time interpreting remotely transmitted adherence or performance data from the digital therapy platform, if payer allows.

`26`	Professional component	Use when billing for the professional interpretation or visit associated with prescribing or monitoring the digital therapy separate from the technical/software license when payer policy allows.
`52`	Reduced services	Use if a reduced course of the digital therapy is provided compared with the full prescribed course.
`53`	Discontinued procedure	Use if the prescribed course was started but discontinued and documentation supports termination for patient safety or other valid reasons.
`54`	Surgical care only	Generally not applicable to software therapy; include only if a related surgical episode is split and this line represents non-surgical responsibility per payer rules.
`55`	Postoperative management only	Generally not applicable; use only if therapy is part of postoperative vision rehabilitation and billing separates management phases.
`62`	Two surgeons	Rare for this service; use only in multidisciplinary cases where two qualified practitioners share responsibility and payer accepts modifier for non-procedural services.
`AS`	Left or right? (Ambulance service)	Not applicable to typical outpatient software therapy but listed among common modifiers; include only if billing rules for specific payer require modality tagging (rare).
`CQ`	Service furnished by a CRNA	Use only when a certified registered nurse anesthetist is involved in a related procedural episode that necessitates modifier reporting — not typical for software-only therapy.
`QK`	Medical direction of two or more CRNAs	Not typically applicable; include only if payer requires reporting in unusual facility contexts.
`TC`	Technical component	Use when the software license or platform access is considered the technical component and the billing party is the vendor or facility providing the software platform.

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