Anthem Blue Cross Connecticut DME.00048 Virtual Reality-Assisted Therapy Systems Form
Procedure is not covered
This document addresses the use of virtual reality systems in the management of pain, cognitive or motor rehabilitation, treatment of procedural anxiety, promotion of weight control, or other medical purposes. Several virtual reality-assisted therapy systems are being investigated for medical use including, but not limited to: RelieVRx (formerly EaseVRx) and SootheVR. Over-the-counter virtual reality systems such as the Oculus headset have also been proposed for therapeutic uses.
Position Statement
Investigational and Not Medically Necessary:
Use of virtual reality systems for screening, diagnosis, or treatment of a health condition is considered investigational and not medically necessary for all indications.