What CMS’s proposed reimbursement codes could mean for the digital therapeutics industry
The Centers for Medicare and Medicaid Services (CMS) has proposed new CPT payment codes for digital therapeutics, marking a significant step towards widespread reimbursement for the DTx products. Previously, CMS introduced Level II HCPCs codes for behavioral health digital therapeutics, which mainly applied to Medicare and Medicaid. The new CPT codes, applicable to all payers, could significantly expand coverage. These codes were included in the 2025 Medicare Physician Fee Schedule proposed rule and are specific to digital therapeutics for mental health conditions. The proposed codes (GMBT1, GMBT2, and GMBT3) allow physicians to bill for digital therapeutics similarly to how they bill for vaccines, covering initial provision, patient education, and ongoing management services. This proposal is expected to lead to broader payer coverage and increase demand from employers, potentially boosting the industry’s sustainability and attracting more investment.
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