This is stated in the “Modernizing Medicare, Advancing Telehealth” plan, with the aim to reimburse physicians who prescribe mobile applications for mental health treatment starting from 2025. This kind of endeaver can be seen as a transition toward the actualization of incorporating the DTx into the conventional mental health management.
To support such integration, the CMS has introduced the following three new payment codes: These codes will be unique to products registered with the food and drugs authority (FDA) only.
The implementation of technologies in mental health care has been relatively low, mainly because of uncertainties regarding the reimbursement and coverage processes. The reason for the limited adoption of these technologies by insurers is questionable long term effectiveness and issues with billing. For instance, Pear Therapeutics that is the first firm to gain FDA clearance for digital therapy said that it was insolvent last year because it could not get adequate insurance reimbursements.
If Medicare were to go through with its proposed policy, other insurers may follow the same path, thus increasing the availability of digital mental health treatments. Its proponents state that these new payment codes are necessary in normalizing the use of digital treatments as part of patients’ clinical management plans. Considering that code is created, Molnar said, “I can’t even express how awesome that is,” he said, CEO of the Digital Therapeutics Alliance.
Such a decision is quite a part of wider strategies adopted by CMS to contain the behavioral health crisis and enhance access to care. The agency also remained open to suggestions to improve on these policies so that they will fit the needs of Medicare beneficiaries.