Summary & Overview
HCPCS A9294: Prescription Digital Cognitive/Behavioral Therapy with Biofeedback
HCPCS Level II code A9294 represents a prescription digital therapeutic intervention delivering cognitive and/or behavioral therapy with biofeedback that is FDA-cleared and billed per course of treatment. As digital therapeutics gain traction, this code captures a growing category of non-drug, software-driven therapies intended for ambulatory or home-based use and prescribed by licensed clinicians. Nationally, recognition of FDA-cleared prescription digital therapeutics has implications for coverage policy, clinical pathways, and billing practices as payers evaluate clinical effectiveness and appropriate reimbursement.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code and its clinical context, summaries of payer coverage considerations, and benchmarks where available. The publication outlines policy developments affecting digital therapeutic coverage, practical billing considerations tied to course-based pricing, and the clinical indications commonly associated with cognitive and behavioral digital programs.
The content highlights what to expect when coding and submitting claims for prescription digital cognitive/behavioral therapy with biofeedback, including the code’s intended use, typical settings, and stakeholder perspectives. Data not provided in the input—such as specific modifiers, associated taxonomies, ICD-10 pairings, payer-specific reimbursement rates, and related codes—are noted as unavailable.
Billing Code Overview
HCPCS Level II code A9294 describes prescription digital cognitive and/or behavioral therapy, biofeedback, FDA cleared, per course of treatment. The code covers prescribed, FDA-cleared digital therapeutic interventions that deliver cognitive and/or behavioral therapy and include biofeedback components as part of a single course of treatment.
Service Type: Prescription digital therapeutic (digital cognitive/behavioral therapy with biofeedback)
Typical Site of Service: Ambulatory or home-based digital therapy delivery
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 34-year-old patient with a history of generalized anxiety disorder and chronic insomnia is seen in primary care for persistent daytime impairment despite medication optimization. The clinician prescribes a course of a prescription digital cognitive and/or behavioral therapy application cleared by the U.S. Food and Drug Administration (FDA) that includes interactive CBT modules and biofeedback training. The prescription is written or electronically transmitted, enrollment is completed by the patient, and the vendor-provided platform delivers a structured course of treatment over several weeks with remote monitoring of engagement and symptom scores. Clinical workflow steps include: initial evaluation and diagnosis; documentation of medical necessity and a signed prescription for the digital therapeutic; patient enrollment and baseline assessments via the app; periodic remote symptom monitoring and messaging through the platform; clinician review of progress during follow-up visits or asynchronous charting; and closure of the course of treatment when the predetermined program is completed or discontinued. Typical sites of service include outpatient primary care clinics, behavioral health clinics, and home use where the patient accesses the prescribed digital therapeutic on a smartphone or tablet.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when the clinician provides an E/M visit that is distinct from the prescription and documentation for the digital therapeutic on the same day |