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Passport by Molina Healthcare policy

Prescription Digital Therapeutics

Prescription Digital Therapeutics is a public Passport by Molina Healthcare policy (policy 412b). It lists 20 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.

View the original policy (PDF) ↗

Payer
Passport by Molina Healthcare
Policy number
412b
Line of business
Medicaid
Source
www.molinaclinicalpolicy.com

Codes in this policy

The CPT and HCPCS codes the policy names. A policy can name a code it excludes.

CodeOther Passport by Molina Healthcare policies
0687TPolicies naming 0687T
0688TPolicies naming 0688T
0704TPolicies naming 0704T
0705TPolicies naming 0705T
0706TPolicies naming 0706T
0740TPolicies naming 0740T
0741TPolicies naming 0741T
99199Policies naming 99199
A9291Policies naming A9291
A9292Policies naming A9292
A9293Policies naming A9293
A9294Policies naming A9294
A9999Policies naming A9999
E1399Policies naming E1399
E1905Policies naming E1905
G0552Policies naming G0552
G0553Policies naming G0553
G0554Policies naming G0554
S9002Policies naming S9002
T1505Policies naming T1505

All Passport by Molina Healthcare policies

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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