CommercialBilling CodesMedium impact
12.00.05g, Prescription Digital Therapeutics and Mobile-Based Health Management Applications
Independence Blue Cross·PA · Pediatrics, Psychiatry, Neurology +4 more·Medical Policy
Effective date
Oct 1, 2026
We identified it
Oct 2, 2026
Summary
Independence Blue Cross updated policy 12.00.05g to add HCPCS code G0685 (algorithm-based ASD assessment using eye-gaze data) effective 10/01/2026. This code addition does not imply a full policy review; the policy maintains its stance that prescription digital therapeutics and mobile-based health management applications are experimental/investigational and NOT covered unless they meet strict FDA approval and clinical evidence criteria.
Action Required
By September 15, 2026: Billing team must update claim denial rules and billing software to recognize HCPCS code G0685 as experimental/investigational under policy 12.00.05g, effective 10/01/2026. Ensure that all claims submitted with G0685 or any prescription digital therapeutic/mobile health management application codes (0687T, 0688T, 0704T, 0705T, A4545, A9291, A9292, A9294, E0737) are automatically denied with rationale: 'Not covered—experimental/investigational digital therapeutic.' Update provider bulletins and encounter templates to clarify that these services are not eligible for reimbursement under Independence Blue Cross commercial plans. Flag any prior authorizations received for these codes and communicate denial to providers. Failure to implement will result in claims being incorrectly processed and paid.