CMS is proposing Medicare reimbursement for FDA-approved digital behavioral therapies.
The agency issued its proposed Medicare Physician Fee Schedule for 2025 July 10. As part of the proposed rule, CMS would add Medicare payment for digital services "furnished incident to or integral to professional behavioral health services."
Digital therapeutics are designed to treat behavioral health conditions, and are accessible through smartphones, virtual reality headsets and other devices. The FDA has approved several therapeutics designed to treat ADHD, insomnia, post-traumatic stress disorder and other conditions.
Medicare reimbursement could open the door to broader payer coverage of digital therapeutics. Pear Therapeutics, which developed digital behavioral interventions, declared bankruptcy in 2023. The company's CEO blamed the bankruptcy on a lack of reimbursement from payers, according to Forbes.
The proposed rule is open for comment until Sept. 9.