Tech & Innovation in Healthcare
Look Forward to Reimbursement for VR-Enhanced Therapy Sessions
Providers help patients solidify skills through VR. Virtual reality (VR) immerses the user in a rich interactive environment that engages their senses. Behavioral, occupational, and physical therapists can use the technology to help their patients build essential skills, and, as of Jan. 1, 2023, the providers may be able to receive reimbursement for their services. Discover the reasons you should report the new Category III CPT® code for VR used with base therapies starting next year, to help pave the way for reimbursement in the future. Add VR to Existing Therapies On July 1, 2022, the AMA released several new Category III codes that will take effect at the start of 2023. Effective Jan. 1, 2023, you can report +0770T (Virtual reality technology to assist therapy (List separately in addition to code for primary procedure)) with an appropriate primary procedure code to represent the practice expense (PE) for the VR technology’s software. According to the CPT® guidelines, this code “may be reported for each session for which the VR technology is used.” The AMA assigns temporary codes to represent emerging technologies, services, and procedures. These temporary codes, better known as Category III codes, consist of four numbers and end with a “T” to signify their temporary status. According to the AMA, Category III codes are “intended to be used for data collection to substantiate widespread usage or to provide documentation for the Food and Drug Administration (FDA) approval process” (www.ama-assn.org/practice-management/cpt/category-iii-codes). Every six months (January 1 and July 1), code changes are published on the AMA website after receiving approval from the CPT® Editorial Panel. For example, the AMA posted new codes related to the use of virtual reality (VR) on their website on July 1, 2022, with an effective date of Jan. 1, 2023. Since Category III CPT® codes are temporary, they may not match one or more of the following Category I code requirements: The AMA archives each code after five years from its inception “unless it is demonstrated that a temporary code is still needed,” according to the introduction to the codes. But when coders begin reporting Category III codes, they might become Category I codes. “Data collected from Category III codes is crucial to establishing Category I codes,” says Kristen R. Taylor, CPC, CHC, CHIAP, associate partner of Pinnacle Enterprise Risk Consulting Services. Note: Medicare and other payers may not reimburse you on Category III codes. However, reporting Category III codes could contribute to creating future Category I codes that will lead to payment. A parenthetical note instructs that +0770T may only be reported with certain CPT® codes, which include, but are not limited to the following: Coders can expect to find this add-on code and the guidelines published in their 2023 AMA CPT® code book. Help Patients Flourish With VR The CPT® Editorial Panel created the Category III code for use with various types of patient therapy, and Floreo is one company, which has developed a VR system that is an ideal companion for the different compatible base therapies. “The Floreo VR system starts with clinically designed VR content aimed to help an individual learner develop a new skill,” says Vijay Ravidran, CEO of Floreo. By wearing a mobile VR headset, the user becomes immersed in an engaging experience. Users of the VR system can build important skills, such as: The headset also pairs with a tablet to allow a health professional or special educator to provide real-time feedback to the user either in person or via telehealth. In the Coach application, the health professional or educator can see what the user is seeing in the headset, offer real-time advice, and record treatment data. Currently, the system is used by speech, occupational, physical, behavioral, and psychological therapists, as well as applied behavioral analysis (ABA) therapy providers. ABA therapy is a type of interpersonal therapy that helps the patient understand how behavior works in real-world scenarios. Ravidran adds that the company is creating the first behavioral therapy metaverse, which is a “virtual world that allows the neurodiverse individuals (those with conditions such as autism, ADHD, and anxiety) to practice and gain real-world skills that generalize to real-world success.” By incorporating VR into a base therapy session, the training or teaching will be enhanced, help the patient retain the knowledge and skills learned, and allow them to translate the skills to real life as the scenarios arise. Since +0770T is designated for VR-mediated therapy, “a therapist performing an eligible base therapy, such as a speech therapy session, will be able to use the new Category III code as a practice session expense,” Ravidran says.
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