Digital Health Therapies for Substance Use Disorders
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This policy describes coverage stance for prescription digital therapeutics (mobile apps/software) intended to treat substance use disorders for Blue Cross Blue Shield - Rhode Island members, distinguishing Medicare Advantage and Commercial products.
Code 98978 is listed as non-covered and considered a contract exclusion for Commercial Products, effective 1/1/2026.
Coverage Criteria for Prescription Digital Therapeutics
Medicare Advantage
Medicare Advantage coverage stance
Commercial Products
Commercial products coverage stance
CPT code 98978 is listed as a non-covered code and considered a contract exclusion for Commercial Products; A9291 is referenced as an example HCPCS code for these therapies.
For Commercial Products, prescription digital therapeutics for substance use disorder (for example, reSET®) are not covered and are considered a contract exclusion.
Use of CPT code 98978 for remote therapeutic monitoring related to digital therapeutics (eg, therapy adherence, therapy response, digital therapeutic intervention) is listed as not covered for Medicare Advantage and as non-covered for Commercial Products.
For Commercial Products, CPT code 98978 is explicitly listed as non-covered and is considered a contract exclusion, effective as noted in the policy.
The evidence base for prescription digital therapeutics for substance use disorder (including opioid use disorder) is limited. Randomized trials and secondary analyses have methodological limitations — including inability to isolate the effect of the digital intervention from contingency management or rewards, negative or uncertain primary outcomes, reliance on retrospective analyses, and uncertainty about the relationship between intermediate measures such as retention and meaningful health outcomes. Given these limitations, the evidence is insufficient to determine that prescription digital therapeutics for SUD or OUD improve net health outcomes.
Relevant Billing and Coding
| 98978 | Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of cognitive behavioral therapy, 16-30 days in a 30-day period (Text Revised Effective 1/1/2026) |
| A9291 | Prescription digital cognitive and/or behavioral therapy, FDA-cleared, per course of treatment |
| 98978 | Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of cognitive behavioral therapy, each 30 days (Text Revised Effective 1/1/2026) |
| A9291 | Prescription digital cognitive and/or behavioral therapy, FDA-cleared, per course of treatment |
| 98978 | Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of cognitive behavioral therapy, each 30 days |
| A9291 | Prescription digital cognitive and/or behavioral therapy, FDA-cleared, per course of treatment |
Provider Actions, Billing, and Verification
Prior authorization — policy-level statement
Prior authorization is not required under this policy.
Prior authorization — verify per member contract
Verify any prior authorization or coverage requirements with the member's contract; the policy does not state a PA requirement and member-specific rules may differ.
- The policy text instructs providers to contact the provider call center for member-specific benefits and authorizations.
Step therapy not specified
No step therapy requirements are specified in this policy.
Provider notice — policy guidance
This policy is informational and not a guarantee of payment; follow member documents and participation agreements for payment and billing rules.
- If services are determined not medically necessary or are non-covered benefits, providers may not charge members unless the member agreed in writing in advance.
Benefit verification required
Benefits may vary between groups and contracts; refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable covered/not covered benefits.
Verify member benefits and eligibility
Verify member eligibility and specific benefits with the provider call center; benefits and eligibility are determined by the member's subscriber agreement, member certificate, or employer agreement.
- Member documents and employer agreements supersede this medical policy for coverage determinations.
Denial risk — 98978 may trigger denial
Claims billed with CPT/HCPCS code 98978 for remote therapeutic monitoring related to digital therapeutics may be denied because the code is listed as not covered.
- 98978 is listed as not covered for Medicare Advantage and is non-covered/contract exclusion for Commercial Products.
Non-covered code — 98978 is a contract exclusion (Commercial)
Use of CPT/HCPCS code 98978 for remote therapeutic monitoring of digital therapeutic interventions is non‑covered and considered a contract exclusion for Commercial Products; claims billed with this code may be denied.
- The policy explicitly lists 98978 as non-covered and a contract exclusion for Commercial Products (Text Revised Effective 1/1/2026).
Clinical Background
Substance use disorder (SUD) refers to harmful or hazardous use of psychoactive substances and is diagnosed using DSM criteria that define problematic patterns across multiple domains; severity is classified as mild, moderate, or severe. Treatment options include behavioral counseling and skills training (notably cognitive behavioral therapy and the community reinforcement approach), medication-assisted treatment for opioid use disorder, contingency management, and long-term follow-up. Prescription digital therapeutics are proposed to deliver CBT-based interventions as adjuncts to outpatient care.
Key Definitions
Therapies and Modalities Mentioned
CBT / digital CBT
CBT goals include recognizing thoughts/behaviors associated with SUD and expanding coping skills; community reinforcement approaches are forms of CBT described in the evidence base.
Contingency management
Examples of incentives and evidence of effectiveness (eg, $250–$300 over 8–12 weeks) are described in trials.
Medication-assisted treatment (context)
Medications are used to suppress withdrawal symptoms and reduce cravings and are often combined with counseling/behavioral therapies.
Prescription digital therapeutics (e.g., reSET, reSET-O)
Remote therapeutic monitoring code 98978 related to digital therapeutic monitoring is listed as non-covered for Commercial Products (contract exclusion) and is listed as not covered for Medicare Advantage.
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