Medical Coverage Policy | Digital Health Therapeutics for Substance Abuse Disorders
Defines the coverage stance for prescription digital therapeutics (eg, reSET®, reSET-O®) for substance use disorder across Medicare Advantage and commercial products, including coding guidance for related CPT/HCPCS codes.
No material clinical or coverage changes reported in this update.
Coverage Summary & Stance
This policy addresses coverage of prescription digital therapeutics for substance use disorders (eg, reSET® and reSET-O®). The policy does not cover prescription digital therapeutics for Medicare Advantage plans and considers them not medically necessary for commercial products because the evidence is insufficient to determine the effects of the technology on health outcomes. Effective date: 01/06/2021; Last review: 04/06/2022. Evidence conclusion: Insufficient to determine the effects of prescription digital therapeutics on health outcomes for substance use disorder and opioid use disorder.
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