Digital therapeutics (DTx) billing got its first dedicated Medicare codes in 2025, when CMS created G0552 through G0554 for digital mental health treatment devices. Outside those codes, a prescription digital therapeutic gets paid through remote therapeutic monitoring, a claim under HCPCS A9291, or a direct contract with a payer or employer, and each route bills from a different entity with different rules.
Key Takeaways
- G0552, G0553, and G0554 let a treating practitioner bill Medicare for supplying an FDA-cleared digital mental health treatment device and managing the patient’s use of it.
- Remote therapeutic monitoring codes, including 98978 for cognitive behavioral therapy devices, can apply when a DTx product reports therapy data to the practitioner.
- HCPCS A9291 describes a prescription digital behavioral therapy per course of treatment, but Medicare generally doesn’t pay for it, so coverage depends on Medicaid and commercial policy.
- The practitioner and the manufacturer bill for different things, and a claim from the wrong one denies.
- There’s no DTx-specific credential. Prescribers credential as usual, and DTx companies that employ clinicians enroll as a group practice.
What Counts as a Digital Therapeutic
A digital therapeutic is software that treats or manages a medical condition and has clinical evidence behind it. The ones that matter most for billing are prescription digital therapeutics, which are cleared or authorized by the FDA and ordered by a clinician. Examples include Rejoyn for major depressive disorder, SleepioRx for chronic insomnia, DaylightRx for generalized anxiety disorder, and EndeavorRx for pediatric ADHD.
General wellness apps, symptom trackers, and coaching programs aren’t digital therapeutics for billing purposes, even when a practice recommends them. No payer reimburses an app just because a clinician suggested it. The billable event is either the FDA-cleared product itself or a practitioner service built around it.
Medicare’s Digital Mental Health Treatment Codes
Starting in 2025, Medicare pays a treating practitioner to supply and manage a digital mental health treatment device used alongside ongoing behavioral health care. The device has to be FDA-cleared under 21 CFR 882.5801, the regulation for computerized behavioral therapy devices for psychiatric disorders.
- G0552 (supply of the device plus initial onboarding and education, per course of treatment)
- G0553 (first 20 minutes of monthly treatment management related to the patient’s use of the device)
- G0554 (each additional 20 minutes of monthly treatment management)
The practitioner has to order the device as part of a behavioral health treatment plan and actually furnish it to the patient. G0552 is priced by each Medicare contractor, so payment varies by region. The management codes require at least one interactive communication with the patient during the month, and the time has to be documented. These codes fit practices already billing behavioral health services, since the device is meant to support an existing plan of care and not replace it.
Remote Therapeutic Monitoring for DTx
When a DTx product sends therapy adherence or response data back to the practitioner, remote therapeutic monitoring codes can apply. 98975 covers initial setup and patient education, and 98978 covers the device supply for cognitive behavioral therapy monitoring. Treatment management bills as 98980 for the first 20 minutes in a month and 98981 for each additional 20 minutes.
RTM has its own rules on data days, time thresholds, and who can order it. Those are covered in our guide to which CPT codes are used in RTM billing. The main risk with DTx is billing RTM for an app that doesn’t meet the FDA medical device definition or doesn’t actually transmit data to the practitioner. Payers look for both.
A9291, Commercial Plans, and Medicaid
HCPCS A9291 describes a prescription digital behavioral therapy, FDA cleared, per course of treatment. It gave manufacturers and pharmacies a way to bill the product itself. Medicare generally hasn’t recognized a benefit category for it, so A9291 claims to traditional Medicare usually deny, while some state Medicaid programs and commercial plans do pay under it.
Commercial coverage is product by product. Some plans cover a DTx under the medical benefit with prior authorization, some route it through the pharmacy benefit, and some cover it only through an employer contract outside the health plan. Coverage criteria usually mirror the FDA indication, so a claim for an off-label use or a patient outside the cleared age range is likely to deny.
Many DTx manufacturers also contract directly with payers and employers on outcomes-based terms, where payment depends on engagement or clinical results. Those agreements sit closer to value-based care than to fee-for-service, and the reporting they require has to be built into the billing workflow from the start. Our post on DTx reimbursement covers the payer side in more depth.
Who Bills for What
The practitioner and the manufacturer bill for different things, and mixing them up is the most common DTx billing error. The treating practitioner bills professional services such as G0552 through G0554, RTM management, and the office visits where the therapy is prescribed and reviewed. The manufacturer, a specialty pharmacy, or a dispensing partner bills for the product itself under A9291 or a payer contract.
A practice can’t bill A9291 for a product the manufacturer ships and bills separately, and a manufacturer can’t bill practitioner management codes. When a DTx company runs its own virtual clinic with employed clinicians, that clinic bills professional services under its own group enrollment, and the product still bills separately.
DTx Credentialing and Enrollment
There’s no separate credential for prescribing a digital therapeutic. Physicians, psychologists, nurse practitioners, and other clinicians who order DTx products are credentialed with payers the same way they would be for any other service, and their scope of practice determines what they can bill.
DTx companies that employ clinicians are a different case. A virtual clinic enrolls with Medicare as a group, each clinician reassigns benefits to it, and every clinician needs a license in each state where patients are located. Commercial plans and Medicaid programs enroll the group and its clinicians separately, and you can’t bill what you can’t credential. Our credentialing team handles multi-state group enrollment and the payer applications that go with it.
Manufacturers billing the product itself need payer contracts, not provider credentialing. Those agreements set the price, coverage criteria, and reporting terms for the product, and they’re handled through payer contracting.
Digital Therapeutics Billing FAQs
Does Medicare pay for digital therapeutics?
In limited cases. Since 2025, Medicare pays treating practitioners for supplying and managing FDA-cleared digital mental health treatment devices under G0552 through G0554. Medicare generally doesn’t pay for the product itself under A9291.
What are G0552, G0553, and G0554?
Medicare codes for digital mental health treatment devices. G0552 covers supplying the device and onboarding the patient, G0553 covers the first 20 minutes of monthly management, and G0554 covers each additional 20 minutes.
What is HCPCS A9291?
A9291 is prescription digital behavioral therapy, FDA cleared, per course of treatment. It’s used to bill the product itself, and coverage depends on the payer since Medicare generally doesn’t recognize it.
Can RTM codes be billed for a digital therapeutic?
Yes, when the product is a medical device that sends therapy data to the practitioner. 98978 covers the device supply for cognitive behavioral therapy monitoring, and 98980 and 98981 cover monthly treatment management.
Who bills for a prescription digital therapeutic?
The practitioner bills professional services such as setup, management, and visits. The manufacturer, pharmacy, or dispensing partner bills for the product.
Is there a special credential for prescribing digital therapeutics?
No. Prescribers are credentialed with payers the same way they would be for any service. DTx companies that employ clinicians enroll as a group practice, and each clinician needs a license in the states where patients are located.
Medwave’s Role for Digital Therapeutics Programs
Medwave works with behavioral health practices adding DTx to their care plans and with DTx companies running their own clinical programs. On the practice side, our medical billing team sets up the DMHT and RTM codes, tracks the monthly time and data requirements, and keeps practitioner services separate from anything the manufacturer bills.
For DTx companies, we handle multi-state group enrollment for employed clinicians, with credentialing averaging 85 days, and we work through payer and Medicaid contracts for the product. If you’re launching a DTx program or adding one to your practice, tell us which product and which payers you’re starting with in the form below.