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CommercialCoverageMedium impact

Prescription Digital Therapeutics (CPB 0999, reviewed 2026-06-19)

Aetna·Family Medicine, General Practice, OB-GYN +6 more·Medical Policy
Effective date
Jun 19, 2026
We identified it
Aug 13, 2026
Days to comply

Summary

Aetna's new CPB 0999 policy (effective 2026-06-19) establishes coverage for FDA-approved fertility awareness apps (Natural Cycles only) as a covered preventive service at one annual subscription per benefit period, while classifying 24 other prescription digital therapeutics as experimental/investigational and therefore non-covered. Billing teams must update systems to recognize HCPCS code A9293 as covered for Natural Cycles only and deny claims for all other PDTs listed in the experimental category.

Action Required

Action needed
By 2026-06-19: Billing team must implement the following changes: (1) Update billing system to ALLOW and process claims for HCPCS code A9293 (Natural Cycles fertility tracking app) with limit of one annual subscription per benefit period per member for Aetna commercial plans; (2) Configure system to DENY claims for A9291, A9292, A9294, E1905, G0552, G0553, G0554, S9002, and T1505 when billed for the 24 specifically listed PDTs (BlueStar Rx, Canvas Dx, DaylightRx, d-Nav, Drowzle Pro, Endeavor Rx, Freespira, Halo AF Detection System, Insulia, Leva, Luminopia One, MindMotion GO, My Dose Coach, myVisionTrack, Nerivio, NightWare, Parallel, Regulora, RelieVRx, reSET, reSET-O, SleepioRx, Somryst); (3) Add internal documentation noting that Natural Cycles is currently the ONLY FDA-cleared fertility app eligible for coverage; (4) Train billing and prior authorization staff to identify PDT claims and apply appropriate coverage rules; (5) Add deny reason codes to claims system explaining experimental/investigational status. Update encounter forms and prior auth templates to flag when providers attempt to order non-covered PDTs. Claims for non-covered PDTs will be denied and remain provider liability.

Affected Billing Codes

A9293
A9291
A9292
A9294
E1905
G0552
G0553
G0554
S9002
T1505