Anthem Blue Cross Blue Shield of California policy
DME.00048 Virtual Reality-Assisted Therapy Systems
DME.00048 Virtual Reality-Assisted Therapy Systems is a public Anthem Blue Cross Blue Shield of California policy (policy DME.00048). It lists 7 CPT or HCPCS codes, 7 of them on the Anthem Blue Cross Blue Shield of California prior authorization list. Not a coverage decision; the payer's own document governs.
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- Policy number
- DME.00048
- Line of business
- Commercial
- Source
- www.anthem.com
Codes in this policy
The CPT and HCPCS codes the policy names. A policy can name a code it excludes. Prior authorization status is from the Anthem Blue Cross Blue Shield of California prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross Blue Shield of California policies |
|---|---|---|---|
| 0770T | On the list | Virtual reality technology to assist therapy | Policies naming 0770T |
| 0771T | On the list | 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 | Policies naming 0771T |
| 0772T | On the list | 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; each additional 15 minutes of intraservice time | Policies naming 0772T |
| 0773T | On the list | 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 | Policies naming 0773T |
| 0774T | On the list | 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; each additional 15 minutes of intraservice time | Policies naming 0774T |
| E1399 | On the list | Durable medical equipment, miscellaneous | Policies naming E1399 |
| E1905 | On the list | Virtual reality cognitive behavioral therapy device (CBT), including pre-programmed therapy software [for example, RelieVRx] | Policies naming E1905 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list