E1905, Virtual reality cognitive behavioral therapy device (cbt), including
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Key Coverage Criteria
- The use of a digital therapeutic product in the treatment or prevention of any health condition is medically necessary when all of the following criteria are met: (A) prescribed by a healthcare practitioner providing medical oversight; (B) FDA-approved for the requested indication; (C) high-quality evidence showing the product improves clinically meaningful net health outcomes as much or more than an established alternative; (D) the improved net health outcome is attainable outside of investigat [...]
3 Active Policies
ANTHEM-DME.00048, DME.00048 Virtual Reality-Assisted Therapy Systems
REGENCE-MED175, Digital Therapeutic Products
REGENCE-MED175.03, Digital Therapeutic Products for Chronic Low Back Pain
Related Codes
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