Key CMS Updates on Digital Mental Health Treatment (DMHT) Devices and Digital Therapeutics

The Centers for Medicare & Medicaid Services (CMS) is preparing to release a significant new rule that will affect hospital outpatient and ambulatory surgical center payment systems, along with various quality reporting programs. While the final rule won't be officially published until November 27, 2024, it's currently available for public inspection.

HCPCS Codes

G0552: Covers the supply and initial setup of a digital mental health treatment (DMHT) device, including onboarding and training as part of a behavioral health therapy plan.

G0553: Applies to the first 20 minutes of monthly management services, where a qualified mental health professional reviews data from the device, interacts with the patient, and monitors progress.

G0554: For each additional 20 minutes of monthly management, covering extended monitoring and review sessions.

Interpretation: By defining these codes, CMS acknowledges the value of digital tools as part of mental health treatment. They establish a billing structure that compensates providers for both device setup and ongoing digital-based therapy management.

Reimbursement and Status Indicator Assignments

G0552 and G0553: Assigned a “V” status, meaning they are eligible for separate payment under the Outpatient Prospective Payment System (OPPS), classified as clinic visit services.

G0554: Assigned a packaged indicator “N,” meaning that its payment is included with G0553 when provided as an add-on service.

Initial Reimbursement: CMS is using APC 5012 (Clinic Visits and Related Services) for G0552 and G0553, facilitating immediate reimbursement under the 2025 payment system with adjustments planned as claims data becomes available. This interim classification and payment level allow CMS to assess the codes’ usage and effectiveness, refining future payments based on real-world data.

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