Comprehensive Guide: Billing and Coding for VR-Mediated Therapy

I. Introduction

This guide outlines billing pathways and coding scenarios for VR-mediated therapy, with a focus on two specific patient populations:

1. Breast cancer patients with secondary depression
2. Chronic pain patients with associated chronic anxiety

II. Billing Pathways

A. Evaluation and Management (E/M) Codes (992XX)

• Strategy: Utilize higher-level E/M codes justified by comprehensive data collected from VR and AI interactions.
• Medical Decision Making (MDM) Considerations:

  • Design VR tools to capture data that supports moderate to high complexity MDM.

  • Ensure VR exercises generate quantifiable data on patient symptoms, functioning, and response to treatment.

  • Implement features that allow for risk assessment and treatment option analysis.

B. Category III CPT Code for VR Treatments (0770T)

• Strategy: Bill using the new Category III CPT code for VR treatments.
• Considerations:
  • Design VR tools to align with the specific requirements of code 0770T.
  • Implement robust data collection to support the value and efficacy of VR treatments, aiding in potential future promotion to a Category I code.

C. Cognitive Behavioral Therapy (CBT) Codes (9083X)

• Note: These codes are specific to psychotherapists and not appropriate for oncologists or neurologists/pain specialists.
• VR Tool Design Considerations:
  • Incorporate CBT principles into VR exercises to support the use of these codes by qualified mental health professionals.
  • Develop features that facilitate documentation of CBT techniques used and patient progress.

D. Chronic Care Management Codes (994XX)

• Note: While not the preferred primary coding method, awareness is important for client discussions.
• VR Tool Design Considerations:
  • Implement features that support care coordination and chronic condition management.
  • Design tools to track time spent on non-face-to-face care activities.

III. Medical Decision Making (MDM) and VR Tool Design

To support higher-level E/M codes and demonstrate the value of VR-mediated therapy, consider the following when designing your VR evaluation and exercise tool: