CommercialBilling CodesMedium impact
12.00.05f, Prescription Digital Therapeutics and Mobile-Based Health Management Applications
Independence Blue Cross·PA · Psychiatry, Neurology, Ophthalmology +2 more·Medical Policy
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross added HCPCS code A9294 (prescription digital cognitive/behavioral therapy with biofeedback, FDA-cleared) to policy 12.00.05f effective 04/01/2026. However, this code remains classified as EXPERIMENTAL/INVESTIGATIONAL and is NOT covered. Billing teams must ensure claims using A9294 are denied and not processed for reimbursement.
Action Required
By April 1, 2026: Billing team must update billing system to recognize HCPCS code A9294 (prescription digital cognitive/behavioral therapy, biofeedback, FDA-cleared) and configure it to DENY all claims automatically. Verify that all related digital therapeutic codes (A9291, A9292, E0737, A4545, CPT 0687T, 0688T, 0704T, 0705T) remain flagged as experimental/investigational in the system. Providers must be notified that A9294 is not a covered benefit—claims submitted will be denied. Update denial messaging to clearly communicate experimental/investigational status. No authorization or payment should be processed for these codes.