Medicare AdvantageCoverageMedium impact
MA12.011g, Prescription Digital Therapeutics and Mobile-Based Health Management Applications
Independence Blue Cross·Pediatrics, Psychiatry, Neurology +1 more·Medical Policy
Effective date
Oct 1, 2026
We identified it
Oct 2, 2026
Summary
Independence Blue Cross Medicare Advantage added HCPCS code G0685 (algorithm-based autism spectrum disorder assessment via eye-gaze technology) to policy MA12.011g effective 10/01/2026. However, this code is classified as EXPERIMENTAL/INVESTIGATIONAL and is NOT covered. The policy clarifies that prescription digital therapeutics and mobile-based health management applications require FDA approval, clinical evidence, and specific criteria to be considered medically necessary; most such services remain non-covered.
Action Required
By October 1, 2026: Billing team must update claim denial protocols and billing system to ensure G0685 and all other prescription digital therapeutics codes listed (0687T, 0688T, 0704T, 0705T, A4545, A9291, A9292, A9294, E0737) are configured to automatically deny as experimental/investigational for Independence Blue Cross Medicare Advantage plans. Update claim scrubbing rules and denial reason codes to reference MA12.011g policy. Front desk staff must be instructed not to schedule or collect copayments for these services, as they are non-covered benefits. Notify providers in writing that any claims submitted for these codes will be denied; advise patients upfront that these digital therapeutics are not covered benefits. Document all denials appropriately to manage member inquiries and appeals.