The Centers for Medicare & Medicaid Services (CMS) has established a new Level II Healthcare Common Procedure Coding System (HCPCS) code to describe “Prescription Digital Behavioral Therapy, FDA Cleared, per Course of Treatment,” which includes Pear Therapeutics Inc’s Somryst, the only FDA authorized prescription digital behavioral therapy for chronic insomnia.
The new HCPCS code is A9291 and it’s scheduled to become effective on April 1, 2022.
“We thank CMS for their decision to establish a new HCPCS code to describe prescription digital therapeutics and facilitate options for payers to provide access to these treatment options in response to Pear’s application,” says Corey McCann, MD, PhD, president and CEO of Pear Therapeutics, in a release. “This is an important reimbursement milestone for healthcare providers, payers, and patients and marks another step towards standard of care for coverage and payment for the PDT [prescription digital therapeutics] category.”
PDTs are a new therapeutic class that uses software to directly treat disease. The US Food and Drug Administration authorized Somryst in 2020. The CMS coding decision was published on February 16, 2022.