Medicare AdvantageBilling CodesMedium impact
MA12.011f, Prescription Digital Therapeutics and Mobile-Based Health Management Applications
Independence Blue Cross·Psychiatry, Neurology, Ophthalmology +1 more·Medical Policy
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated MA12.011f to MA12.011g, adding HCPCS code A9294 (Prescription digital cognitive and/or behavioral therapy, biofeedback, FDA cleared) to the policy effective 04/01/2026. This code is classified as EXPERIMENTAL/INVESTIGATIONAL and is NOT covered under Medicare Advantage plans. Billing teams must ensure this code is not billed or is immediately denied if submitted.
Action Required
By April 1, 2026: Billing team must update billing system to deny or reject claims for HCPCS code A9294 (Prescription digital cognitive and/or behavioral therapy, biofeedback, FDA cleared) and all other listed codes (0687T, 0688T, 0704T, 0705T, A4545, A9291, A9292, E0737) as these are classified as EXPERIMENTAL/INVESTIGATIONAL and NOT covered under Independence Blue Cross Medicare Advantage plans. Configure system edits to automatically deny these codes with denial reason: 'Experimental/Investigational - Not Covered.' Inform providers and clinical staff that these prescription digital therapeutic services cannot be billed to Medicare Advantage members. Train front desk and billing staff to communicate to patients that these services are not covered benefits. Any claims submitted for these codes will be denied; no appeals process will override this policy.