CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

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.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyMedical Coverage Policy | Digital Health Therapeutics for Substance Abuse Disorders

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 6, 2021

Next Review Date

Key ActionBenefits may vary between groups and contracts; providers must refer to the applicable Benefit Booklet, Evidence of Coverage, or Subscriber Agreement to confirm member-specific coverage.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes reported in this update.

2Pivotal RCTs cited

1FDA-cleared DTx mentioned

1HCPCS A9291 available

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.