Take me away — virtual reality (VR) coding rules for 2023 – Rehab Realities

Renee Kinder

“Hey, you are McKnight’s lady?”

“The one who writes about rehabilitation.”

I really am.

I’ve heard those lines a lot over the last few months of the conference season.

The questions also often come with the feeling that my reality is somewhat different than others. That I somehow have special inside knowledge or a greater sense than others about what’s going on in the industry.

It’s simply not true.

I started my career as an SLP. I’ve always enjoyed writing, so much of what you see in Rehab Realities comes from rulemaking and publicly available information.

My real life comes with the same daily annoyances we all face.

Take, for example, the day I returned home from visiting family for Thanksgiving to not one, not two, but three disasters.

A broken washing machine that refused to drain and basically flooded the laundry room.

A broken dishwasher… not much worse for a family of seven.

And to top it off there was a leak in the roof that was draining into the two showers and down the living room wall.

Please get me out of here, I say to myself. Anywhere but here.

Do you feel that our patients may feel the same way at times?

They miss the warmth and comfort of their homes, long to see and experience the sound of the ocean, return to special places associated with childhood memories, and so on…

In addition, virtual reality (VR) research is growing for the treatment of pain, chronic conditions, mental health and more.

What if, as rehabilitation professionals, we could use VR to support these experiences and report their benefits to payers?

In 2023, exactly that will become a reality with the new VR Level III CPT® add-on code 0770T.

To get started, we need to understand the intent of CPT® Level III codes.

Category III codes are temporary CPT® codes representing new technology and have specific criteria.

The following criteria are used by the CPT/HCPAC Advisory Committee and the CPT® Editorial Panel to evaluate Category III code requests:

  • The procedure or service is currently or recently performed on A people

At least one of the following additional criteria was met:

  • The application is supported by at least 1 CPT® or HCPAC consultant representing practitioners who would use the procedure or service (or)
  • The actual or potential clinical effectiveness of a particular procedure or service is supported by peer-reviewed literature that is available in English for review by the CPT® Editorial Panel (or)
  • Here is:
  • At least one Institutional Review Board approved study protocol for the procedure or service performed
  • A description of a current and ongoing trial in the United States that outlines the effectiveness of the procedure or service or
  • Further evidence of evolving clinical use
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Their price and coverage depends on the discretion of individual payers. 0770T will be discontinued in January 2028 unless converted to a permanent CPT® code or renewed as a Category III code for another five years.

Next, let’s look at the intended use of the 0770T.

Virtual reality technology can be integrated into various types of patient therapy as an adjunct to basic therapy. Code 0770T is an additional code that represents the cost to the practice for software used for VR technology and may be reported for each session for which VR technology is used.

VR technology is incorporated into the basic therapy session and is used to enhance the training or teaching of the skill that the therapy is focused on.

Code 0770T does not charge any additional reported therapist time beyond that already reported for the basic therapy code: 0770T Virtual reality technology for assisting therapy. (List separately except for the code for the primary procedure.)

The following CPT® codes can be used in conjunction with 0770T and should only be reported once per session.

Psychotherapy Codes: Psychotherapy is the treatment of mental illness and behavioral disorders in which a physician or other qualified health professional attempts, through definitive therapeutic communication, to alleviate emotional disturbances, reverse or change maladaptive behavior patterns, and promote personality growth and development. -90832, 90833, 90834, 90836, 90837, 90838, 90847, 90849, 90853

  • 90832 Psychotherapy, 30 minutes with the patient
  • 90833 Psychotherapy, 30 minutes with the patient during implementation
  • 90834 Psychotherapy, 45 minutes with the patient
  • 90836 Psychotherapy, 45 minutes with the patient during implementation
  • 90837 Psychotherapy, 60 minutes with the patient
  • 90838 Psychotherapy, 60 minutes with the patient during implementation
  • 90847 Family psychotherapy (joint psychotherapy)
  • 90849 Multifamily Group Psychotherapy
  • 90853 Group psychotherapy (other than multiple group)
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Behavioral Health Assessment and Intervention Codes: Behavioral health assessment and intervention services are used to identify and address psychological, behavioral, emotional, cognitive, and interpersonal factors relevant to the assessment, treatment, or management of physical health problems.

The patient’s primary diagnosis is physical in nature, and the focus of assessment and intervention is on factors complicating medical conditions and treatment. These codes describe assessments and interventions to improve a patient’s health and well-being using psychological and/or psychosocial interventions designed to alleviate specific problems related to the illness — 96158, 96159, 96164, 96165, 96167, 96168, 96170, 96170, 96170.

  • 96158 Behavioral Health Interventions, Individual, Face-to-Face; initial 30 minutes
  • 96159 every next 15 minutes
  • 96164 Health behavior intervention, group (2 or more patients),
  • 96165 every next 15 minutes (list separately except code for primary service)
  • 96167 Health Behavior Intervention, Family (with Patient)
  • 96168 every next 15 minutes (list separately except code for primary service)
  • 96170 Behavioral Health Interventions, Family (Non-Patient)
  • 96171 every next 15 minutes (list separately except code for primary service)

Adaptive Behavior Treatment Codes that describe services that address specific treatment goals and objectives based on the results of previous evaluations (see 97151, 97152, 0362T), and include ongoing evaluation and modification of treatment protocols, goals, and objectives: 97153, 97154, 97155, 97158.

  • 97153 Protocol-based adaptive behavior therapy, administered by a technician under the direction of a physician or other qualified healthcare professional, face-to-face with one patient, every 15 minutes
  • 97154 Protocol-based adaptive behavior group therapy, conducted by a technician under the direction of a physician or other qualified health care professional, face-to-face with two or more
  • 97155 Adaptive behavior therapy with protocol modification, administered by a physician or other qualified health care professional, which may include simultaneous guidance by a technician, face-to-face with one patient every 15 minutes
  • 97158 Group adaptive behavior therapy with protocol modification delivered by a physician or other qualified healthcare professional, face-to-face with multiple patients, every 15 minutes

Finally in the series of codes are those traditionally used by rehabilitation professionals including: 92507, 92508, 97110, 97112, 97129, 97150, 97530, 97533, 97535, 97537

  • 92507 Speech, language, voice, communication,
  • 92508 (above) group, 2 or more individuals
  • 97129 Therapeutic interventions that target cognitive functions (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies for managing activity performance (eg, managing time or plans, initiating, organizing, and sequencing tasks), direct (personal) contact with the patient; initial 15 minutes
  • 97110 Therapeutic procedure, one or more areas, every 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
  • 97112 neuromuscular re-education of movement, balance, coordination, kinesthetic sensation, posture and/or proprioception for sitting and/or standing activities
  • 97150 Therapeutic procedures, group (two or more individuals)
  • 97530 Therapeutic activities, direct (1 on 1) patient contact (use of dynamic activities to improve functional performance), every 15 minutes
  • 97533 Sensory integration techniques to improve sensory processing and support adaptive responses to environmental demands, direct (one-on-one) patient contact, every 15 minutes
  • 97535 Self-care/home management training (eg, activities of daily living and compensatory training, meal preparation, safety procedures, and instructions for use of assistive technology/adaptive equipment) one-on-one direct contact, every 15 minutes
  • 97537 Community/Work Reintegration Training (eg, shopping, transportation, money management, occupational activities and/or work environment analysis/modifications, job task analysis, use of assistive technology/adaptive equipment), direct face-to-face, each 15 minutes
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Additionally, 0770T will be discontinued in January 2028 unless converted to a permanent CPT® code or renewed as a Category III code for another five years. Providers should check with payers for compliance with usage. As with all new submissions, we must exercise due diligence to promote coding accuracy to ensure continued development and care delivery to those we serve.

For us, VR may just be a new tool to facilitate patient success… how can you use it to take patients to new levels of reality?

Renee Kinder, MS, CCC-SLP, RAC-CT, is the executive vice president of clinical services for Broad River Rehab and the 2019 APEX Award of Excellence winner in the category of Writing – Regular Departments and Columns. In addition, she serves as the Gerontology Professional Development Manager for the American Speech Language Hearing Association (ASHA) Gerontology Task Force, is a University of Kentucky College of Medicine Community Fellow, and is the CPT Advisor for Current Procedural Terminology of the American Medical Association. ® Editorial panel. She can be reached at [email protected]

The views expressed in McKnight’s Long-Term Care News guest posts are the author’s and are not necessarily posts from McKnight’s Long-Term Care News or its editors.

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