On December 2, 2021, Aimed Alliance submitted a comment to the Centers for Medicare and Medicaid Services (CMS) urging them to create a HCPCS code for prescription digital therapeutics (PDTs) to expand patient access to these therapeutics. Our comment recognized that while some medical devices may qualify to use HCPCS Level 1 codes, also known as Current Procedural Terminology (CPT) codes, PDTs that are software-only need a HCPCS Level 2 code for several reasons. Our comment explained that when a provider bills using a CPT code, the PDT must be provided to the patient in the provider’s office. Thus, a HCPCS Level 2 code is more appropriate for software-only PDTs which are delivered via a specialty pharmacy. Our comment can be read here.
Additionally, in conjunction with our comment to CMS Aimed Alliance also released a fact sheet on CPT and HCPCS Level 2 codes. The fact sheet explains the difference between CPT codes and HCPCS Level 2 codes and the need for CMS to create a billing pathway for PDTs to ensure that administrative barriers do not impair patient access to these therapeutics. The fact sheet can be found here.
Last Updated on December 8, 2021 by Aimed Alliance
