T1505, Electronic medication compliance management device, includes all components and
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Key Coverage Criteria
- Mobile-based health management applications are consideredmedically necessarywhenallof the following criteria in I and II have been met:
- Criteria to evaluate the mobile software application (MSA):The MSA has been approved or cleared by the Food and Drug Administration (FDA);andThere is credible scientific evidence which permits reasonable conclusions regarding the impact of the MSA on health outcomes;andThe MSA has been proven materially to improve the net health outcome or be as beneficial as any established alternative;AND
- The MSA has been approved or cleared by the Food and Drug Administration (FDA);and
- There is credible scientific evidence which permits reasonable conclusions regarding the impact of the MSA on health outcomes;and
- The MSA has been proven materially to improve the net health outcome or be as beneficial as any established alternative;AND
- Criteria to evaluate the appropriateness of the MSA for the individual:The MSA has been prescribed by a healthcare practitioner;andThere is documentation supporting that the MSA was ordered for a covered purpose such as preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and in accordance with generally accepted standards of medical practice;*andThe requested MSA is not primarily for the convenience of the individual, prescribing clinician, caregiver, or o [...]
1 Active Policy
ANTHEM-CG-ANC-08, CG-ANC-08 Mobile Device-Based Health Management Applications
Related Codes
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