Medicare AdvantageCoverageMedium impact
MA12.011e, Prescription Digital Therapeutics and Mobile-Based Health Management Applications
Independence Blue Cross·Neurology, Physical Therapy, PM&R (Physical Medicine & Rehab) +4 more·Medical Policy
Effective date
Dec 29, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated MA12.011e to MA12.011g, adding 13 new prescription digital therapeutics and mobile-based health management applications to the experimental/investigational (non-covered) category. Two new CPT codes (0733T, 0734T) and two new HCPCS codes (E0738, E3200) were added to the policy effective 12/29/2025. All services related to these applications remain non-covered under Medicare Advantage plans.
Action Required
By December 29, 2025: Billing team must update billing system and claim submission software to flag and deny claims submitted under CPT codes 0733T, 0734T and HCPCS codes E0738, E3200 for Medicare Advantage plans. Add these codes to the non-covered/experimental services list in the billing system. Notify providers that these codes, along with associated services (setup, training, collection, interpretation, assessment, and management), are not eligible for reimbursement. Update claim rejection messages to reference policy MA12.011g. Verify no claims for these codes or related prescription digital therapeutic services are processed for coverage; all should be denied as experimental/investigational.