In the Current Procedural Terminology (CPT®) 2023 code set, four Category III codes (0771T-0774T) were established to report virtual reality (VR) procedural dissociation services effective January 1, 2023. A new Category III subheading with guidelines and a table were added to outline patient age and duration of service and to identify who performs the service. Refer to the CPT 2023 code set for detailed information on these changes. This article provides an overview of the intent and use of these new codes.

Virtual Reality Patient Procedural Dissociation

Virtual reality (VR) procedural dissociation is a VR-based state of altered consciousness that supports and optimizes the patient’s comfort, increases procedural tolerance, and decreases the patient’s pain during the associated procedure. VR procedural dissociation establishes a computer-generated audio, visual, and proprioceptive immersive environment in which patients respond purposefully to verbal commands and stimuli, either alone or accompanied by light tactile stimulation. VR procedural dissociation does not involve interventions to maintain cardiovascular function, patent airway, or spontaneous ventilation.

VR procedural dissociation codes 0771T, 0772T, 0773T, 0774T are not used to report administration of medications for pain control, minimal sedation (anxiolysis), moderate sedation (99151, 99152, 99153, 99155, 99156, 99157), deep sedation, or monitored anesthesia care (00100-01999). Time spent administering VR procedural dissociation cannot be used to report moderate sedation or anesthesia services. VR procedural dissociation is not reported for patients younger than 5 years of age.

For 0771T, 0772T the independent, trained observer is an individual who is qualified to monitor the patient during the procedure and has no other duties (eg, assisting at surgery) during the procedure. This individual has undergone training in immersive technologies and can adjust the technology under the supervision of the physician or other qualified health care professional who is performing the procedure. If the physician or other qualified health care professional who provides the VR also performs the procedure supported by VR (0771T, 0772T), the physician or other qualified health care professional will supervise and direct the independent, trained observer who will assist in monitoring the patient’s level of consciousness, procedural disassociation, and physiological status throughout the procedure.

Intraservice time is used to determine the appropriate code to report VR procedural dissociation and is defined as:

• beginning with administration of the immersive VR technology, which at a minimum, includes audio, video, and proprioceptive feedback;
• requiring continuous face-to-face attendance of the physician or other qualified health care professional. Once continuous face-to-face time with the patient has ended, additional face-to-face time with the patient is not added to the intraservice time;
• ending when the procedure and the administration of the VR technology ends and the physician or other qualified health care professional is no longer continuously face-to-face with the patient;
• requiring monitoring patient response to the VR procedural dissociation, including:
  • periodic assessment of the patient;
  • monitoring of procedural tolerance, oxygen saturation, heart rate, pain, neurological status, and global anxiety;
  • altering of and/or adjustment of the VR program to optimize the dissociated state based on patient tolerance of the associated.
  • Optimization techniques include:
    • changing the VR baseline software program and/or adjustment of program volume;
    • adjusting the visual virtual environment;
    • altering the visual virtual position of the VR program to enable patient repositioning;
    • changing an embedded video programming in the virtual environment to maintain the dissociated state; and
    • utilizing and adjusting a proprioception, olfactory, or tactile feedback loop that corresponds to the VR program to achieve a proper and/or deeper dissociated state.

Preservice work and time are not reported separately and include the initial ordering and selecting of the VR program, describing VR procedural dissociation to the patient and/or family, and applying the VR device to the patient prior to starting the procedure. Postservice work and time is not reported separately and begins with the end of the procedure, the termination of the VR technology, and when the physician or other qualified health care professional is no longer continuously face-to-face with the patient.

 0771T Virtual reality (VR) procedural dissociation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the VR procedural dissociation supports, requiring the presence of an independent, trained observer to assist in the monitoring of the patient’s level of dissociation or consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older

 0772T each additional 15 minutes intraservice time (List separately in addition to code for primary service)

(Use 0772T in conjunction with 0771T)

 0773T Virtual reality (VR) procedural dissociation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the VR procedural dissociation supports; initial 15 minutes of intraservice time, patient age 5 years or older

 0774T each additional 15 minutes intraservice time (List separately in addition to code for primary service)

(Use 0774T in conjunction with 0773T)

VR technology allows the implementation of VR procedural dissociation to avoid anesthesia during painful and anxiety-provoking medical, surgical, and radiological procedures. VR technology has been used as an anesthesia replacement for adult and pediatric patients in the setting of severe burns, rehabilitation, radiological interventional procedures, gastroenterology procedures, orthopedic procedures, oncology therapies, dermatologic procedures, otolaryngologic endoscopy, and vascular access procedures. VR dissociation is typically performed with a wide variety of diagnostic, therapeutic, and interventional services.

Codes 0771T and 0772T include an independently trained observer who is qualified to monitor the patient and has no other duties (eg, assisting at surgery) during the procedure. This individual has undergone training in immersive technologies and can assist in monitoring the patient’s level of consciousness, procedural dissociation, and physiological status throughout the procedure and adjust the technology under the supervision of the physician or other qualified health care professional (QHP) who is performing the procedure that is being supported by VR.

Codes 0773T and 0774T are reported for VR dissociation services when provided by a physician or other QHP other than the physician or other QHP who is performing the service being supported by the VR procedural dissociation.

Coding Tip

Use of VR codes requires audio, visual, and proprioceptive immersive environment. This is noted to clearly distinguish VR codes from audio and/or visual techniques routinely used to calm/relax patients (ie, distraction or anxiolysis).

The introductory guidelines provide specific details on the preservice work, intraservice time, and postservice work. Note that:

• Intraservice time is used to determine the appropriate code to report VR procedural dissociation.
• Preservice work and time are not reported separately and include the initial ordering and selecting of the VR program, describing VR procedural dissociation to the patient and/or family, and applying the VR device to the patient prior to the start of the procedure.
• Postservice work and time are not reported separately, and it begins with the end of the procedure, the termination of the VR technology, and when the physician or other QHP is no longer continuously face-to-face with the patient.

A table was included to assist users in selecting the appropriate code combination to report the VR procedural dissociation by the same physician or other QHP (same physician or other QHP performing the procedure that VR is supporting) or VR procedural dissociation by a different physician or other QHP (not the physician or other QHP who is performing the procedure that VR is supporting). The table displays the ranges of time taken for VR procedural dissociation. The rows in this table illustrate the time taken to perform the VR procedural dissociation (as a range), the age of the patient, and the appropriate code(s) to report based on the time within that range. To make the table user-friendly, minutes have been captured in the left column to identify the time. The table specifies that VR procedural dissociation services of less than 10 minutes for a patient of any age are not separately reported.

Coding Tip

VR is not reportable for patients under 5 years of age. For patients who are 5 years old or older, an intraservice time of under 10 minutes is not reportable.

The following clinical examples and procedural descriptions reflect typical clinical scenarios for which these new codes would be appropriately reported.

Clinical Example (0771T)

An 8-year-old male patient undergoes a procedure that requires virtual reality (VR) procedural dissociation.

Description of Procedure (0771T)

The physician or other QHP performs patient assessment prior to initiation of VR procedural dissociation; supervises or personally provides VR procedural dissociation; and supervises an independent, trained observer who monitors the patient’s level of consciousness and physiologic status throughout the procedure. Assess the patient continuously throughout the procedure to achieve an effective and safe level of procedural dissociation. The physician orders or provides adjustment of VR procedural dissociation as needed. The physician orders additional administration of VR procedural dissociation as needed to maintain the desired level of procedural dissociation for the supported procedure. The physician’s intraservice time ends when the procedure is complete, the patient is physiologically stable, and face-to-face physician time is no longer required.

Clinical Example (0772T)

A 15-year-old male undergoes a procedure that requires VR procedural dissociation. [Note: This is an add-on service. Only consider the additional work related to code 0771T.]

Description of Procedure (0772T)

After the initial 15 minutes of VR procedural dissociation (reported separately with 0771T), provide additional VR procedural dissociation to complete the supported procedure. The physician performing the procedure, who is also administering VR procedural dissociation, monitors the patient closely and delivers additional VR procedural dissociation as needed.

Clinical Example (0773T)

A 5-year-old female undergoes a procedure that requires VR procedural dissociation performed by a separate physician or other QHP.

Description of Procedure (0773T)

A physician or other QHP (separate from the physician performing the supported procedure) performs patient assessment prior to the initiation of VR procedural dissociation, personally provides the VR procedural dissociation and supervises the patient’s level of consciousness and physiologic status throughout the procedure. The physician provides adjustment and additional administration of VR procedural dissociation as needed to maintain the achieved level of procedural dissociation for the supported procedure. The physician’s intraservice time ends when the procedure is complete, the patient is physiologically stable, and face-to-face physician time is no longer required.

Clinical Example (0774T)

A 16-year-old female undergoes a procedure that requires VR procedural dissociation performed by a separate physician or other QHP. [Note: This is an add-on service. Only consider the additional work related to code 0773T.]

Description of Procedure (0774T)

After the initial 15 minutes of VR procedural dissociation (reported separately with 0773T), perform additional VR procedural dissociation to complete the supported procedure. The physician performing the VR procedural dissociation closely monitors the patient and provides additional VR procedural dissociation as needed.

References: CPT assistant October month