Chronic pain has a substantial economic impact on the United States, costing an
estimated $635 billion annually. While VR has been studied and used in various
acute and chronic pain conditions for decades, headset technology has only
recently become simple to use and broadly accessible, and it continues to improve.
AppliedVR, a California-based company pioneering immersive virtual reality for
medical therapeutic use, has achieved a remarkable feat, working with the Centers
for Medicare & Medicaid Services (CMS) to include RelieVRx® in the existing benefit
category for durable medical equipment (DME), the first immersive VR therapeutic
to follow this strategy to tap into existing payment authority.
Home-based VR therapies like RelieVRx® hold the potential to broaden access
to effective and on-demand nonpharmacologic treatments for chronic lower
back pain that are durable well beyond the end of treatment. Understanding
reimbursement as a combination of coding, coverage, and payment provides the
context for the hurdles all new technologies must clear. Regulatory strategy may
be underappreciated in terms of its influence on reimbursement success, and this
was certainly key to the decisions related to code assignment and granting the
benefit category as DME for RelieVRx®.
Understanding the intricacies of reimbursement codes and benefit categories is
crucial for innovators seeking to navigate the evolving landscape of virtual reality
in healthcare. It is essential to keep an eye on emerging trends and codes to make
informed decisions and leverage opportunities for reimbursement in this rapidly
evolving field. Founders of VR healthcare companies should vigilantly monitor the
evolving reimbursement landscape and how changes may influence their business
model. By capitalizing on these established reimbursement options and staying
attuned to emerging trends, healthcare providers can harness the full potential
of VR technology in delivering innovative and effective treatments.
