In the US, CMS pays for exactly one billing code specific to VR in health care, HCPCS E1905, and it covers prescription VR for chronic low back pain (RelieVRx, first authorised as EaseVRx). It is an FDA class II device for use at home, and Medicare gives it its own billing code, but no coverage is mandated. VR exposure therapy for anxiety disorders has solid trial evidence behind it. VR for stroke rehabilitation shows benefits of low to moderate certainty. Cybersickness, headset strain, hygiene and cost all count against VR in clinical use.
The rest of this page goes through each tier: what is authorised, what is paid for, what the trials actually measured, and what tends to hold programmes back.
What does VR mean in healthcare, and what are its main clinical uses today?
In a hospital or clinic, VR means a head-mounted display that puts the patient or clinician inside a computer-generated environment. Augmented reality is different: it overlays images on the real world. The FDA lists treatment areas for AR and VR together: pain management, mental health, neurological disorders, surgery planning, intraoperative procedures, ophthalmic diagnostics, telemedicine, virtual care, paediatrics and rehabilitation. (If the line between the two technologies matters for your project, we cover it in what is the difference between AR and VR.)
The FDA gives three examples of these technologies already being used with patients: a VR system for post-traumatic stress disorder in army veterans, a VR rehabilitation therapy that simulates real-life situations after a stroke, and an AR system that overlays medical images on the patient during surgery. The FDA also publishes an AR/VR Medical Device List. Every device on it has met the agency’s premarket requirements, including a review of safety and effectiveness for its intended use.
We sort clinical uses into three groups. Therapeutic VR treats a condition (pain, anxiety, phobias). Training VR teaches a skill (laparoscopic technique, for example). Rehabilitation VR gives motor or functional practice. Each group has a different evidence base, so the rest of this page keeps them separate. Wider, non-clinical examples of virtual reality are covered separately.
Which VR healthcare uses are FDA-cleared or reimbursed, and which are still research?
One cleared use is in-home VR for adults with chronic low back pain. The FDA granted EaseVRx a De Novo authorisation as a class II prescription device, in a new device type called “virtual reality behavioral therapy device for pain relief”. The product was renamed RelieVRx, and its De Novo clearance dates from 2021. It is indicated for adults aged 18 and over with moderate to severe low back pain lasting more than three months. It is an adjunctive treatment based on cognitive behavioural therapy skills, used at home.
The FDA decision summary sets out the evidence. A randomised, placebo-controlled trial assigned 188 people with chronic low back pain to EaseVRx or a sham programme, and the difference was statistically significant on all five primary endpoints. EaseVRx patients achieved a 30% reduction in pain at end of treatment, sustained through 1, 2 and 3 months of follow-up; 41% of sham patients reached a 30% or greater reduction, but it was not sustained. For pain interference with activity, mood, sleep and stress, an average of 73% of EaseVRx patients reached a 30% or greater reduction, against an average of 58% for sham.
The authorisation also set special controls. Clinical testing has to validate the behavioural therapy model as the device implements it and evaluate all adverse events. The patient-contacting parts have to be biocompatible. Software verification, validation and hazard analysis are required. The labelling has to warn about nausea, motion sickness and headset discomfort. The trial recorded nausea, motion sickness and headset discomfort. All of it was temporary and went away when patients stopped or adjusted the device, and there were no device-related serious adverse events.
The FDA later cleared a new hardware version, RelieVRx (Pico G3), through a 510(k), finding it substantially equivalent to its predicate. That submission includes a Predetermined Change Control Plan: a risk-based protocol for future hardware platform changes that do not alter the intended use or the therapeutic content. This matters for engineering. The software is locked to the device, and future hardware platform changes follow the cleared change control plan.
Outside the US, NICE published an early value assessment of VR technologies for agoraphobia or agoraphobic avoidance (HTE15) on 15 November 2023, since moved to HealthTech guidance 701.
Status of the main clinical VR uses at a glance
| Use | Regulatory status | Payment route | Strength of evidence | Stage |
|---|---|---|---|---|
| In-home VR for chronic low back pain (RelieVRx) | FDA De Novo, class II; later 510(k) for new hardware | HCPCS E1905; coverage decided claim by claim | Randomised sham-controlled trial, 188 patients | Cleared for in-home prescription use |
| VR exposure therapy for anxiety, phobias, PTSD | FDA names a VR system for PTSD in veterans as in use | Category III add-on code 0770T with a behavioural health service | Meta-analysis of 30 RCTs | Validated; adoption limited |
| VR for stroke rehabilitation | FDA cites a VR rehabilitation therapy | Category III add-on code with gait training | Cochrane review, moderate to low certainty | Modest benefit |
| VR procedural dissociation for pain during procedures | - | Category III codes 0771T-0774T | - | Emerging |
Once you know which cleared or reimbursed use you are aiming at, the next decision is the headset and compute architecture. We cover that in standalone vs PC-tethered headsets for clinical therapy and training. For PC-tethered setups, our guide to Zen 4 (znver4) for clinical VR workstations explains what that CPU architecture means in practice. If you tether headsets across many rooms, our guide to active optical cables (AOC) for clinical VR covers cabling at scale.
Is VR therapy covered by Medicare or private insurance?
Partly, through a narrow set of routes. CMS pays for exactly one VR-specific code, HCPCS E1905 (“virtual reality cognitive behavioral therapy device”), which it created on 21 March 2023 after an application from AppliedVR. The code took effect on 1 April 2023. CMS also classified RelieVRx as durable medical equipment, the first VR therapeutic device to receive both a HCPCS code and a DMEPOS benefit category. According to Nixon Law Group, CMS paid between $549 and $646 for E1905 as of April 2024.
None of this guarantees payment. CMS did not mandate coverage or set a specific payment. It left coverage and payment to the Medicare Administrative Contractors, claim by claim. CMS also said it wanted to understand what a VR device achieves that the same software on a computer, tablet or phone would not. Part of the reason CMS classed it as equipment was that the software is locked to the headset and cannot run on personal devices.
The American Medical Association has created several VR CPT codes on a Category III basis. These are codes for emerging technology, meant to collect data on use, efficacy and outcomes. The AMA does not value them, CMS has set no national rate, and commercial payers may or may not cover them. The codes expire in 2028 unless the AMA extends them or sets permanent payment. Codes 0770T and 0791T are add-ons: 0770T for VR alongside a behavioural health service, 0791T only with therapeutic gait training. Codes 0771T to 0774T cover VR procedural dissociation. Most public and commercial payers do not yet cover headsets. Digital therapeutics codes such as A9291 exist, but none is specific to VR.
Where a cleared device has a billing code, the case for continued funding rests on claims and outcomes. A Category III code exists precisely to collect that data, so reporting it consistently is worth doing even when the claim is not paid.
Where VR therapy is clinically validated, and where it is still a pilot
VR exposure therapy for anxiety has been tested in 30 randomised trials. A meta-analysis of randomised controlled trials, updating Powers and Emmelkamp’s 2008 analysis, found 30 studies with 1,057 participants covering specific phobias, social anxiety, PTSD and panic disorder. It estimated a large effect for VR exposure therapy against waitlist (g = 0.90), a medium to large effect against psychological placebo (g = 0.78), and no significant difference from in vivo exposure (g = -0.07), with results fairly consistent across disorders. For anxiety disorders, the trial evidence puts VR exposure therapy roughly level with exposure in real life, which makes adoption, not efficacy, the open question.
Stroke rehabilitation evidence is of moderate to low certainty. The Cochrane review finds moderate- to low-certainty evidence that VR and interactive video gaming are slightly better than alternative therapy for upper limb function, balance and activity limitation, with bigger gains when VR is added to usual care and so increases total therapy time. People may not gain walking speed or quality of life. One version of the review found no significant difference from conventional therapy for upper limb function (SMD 0.07, 22 studies, 1,038 participants), but a significant one when VR was added to usual care (SMD 0.49, 10 studies, 210 participants), both rated low quality. Very few of the included studies used immersive VR through a headset. That limits how far the review speaks to headset-based rehabilitation in particular.
Individual VR studies are often criticised for low quality and small samples. Ongoing trials continue to test VR across behavioural health, physical therapy and visual impairment.
Surgical training
The Cochrane review of VR for laparoscopic trainees with limited experience included eight trials covering 109 trainees. Trainees with VR training operated faster than those with no extra training (3 trials, 49 participants, mean difference -11.76 minutes). Operative performance also improved, though it was hard to quantify. Every trial was at high risk of bias. None reported death, complications, quality of life or length of stay, so the effect on patients and costs is unknown. Skill metrics for VR outside the clinic are discussed in VR in education and learning outcomes. VR in animal care is covered in VR and AI in veterinary clinics.
What do doctors and clinicians say about using VR in patient care and medical training?
Surgical trainees in one UK survey were broadly in favour. In that national survey of 91 trainees, foundation doctors and medical students, 91.3% agreed that VR should be both an adjunct to surgical training and a competency-based assessment tool. Respondents also reported barriers to access, and senior surgeons found access notably harder. The authors present VR simulation as a high-fidelity, low-risk response to the shortage of case volume trainees face.
Therapists report a range of barriers. A study of clinical psychologists and psychotherapists grouped barriers into four themes: professional (lack of knowledge, training, time), financial (cost, cost-benefit ratio), therapeutic (clinical applicability, worries about the “real” therapeutic relationship) and technological (immature technology, cybersickness, no equipment). The authors note that VR remains largely confined to research and specialised settings, and that evidence-based treatments for mental disorders typically take more than a decade to reach routine practice.
The US Department of Veterans Affairs, through its VA Immersive office, works with AppliedVR to give veterans VR therapy for chronic low back pain, according to trade press reporting.
Disadvantages of VR in healthcare and how clinical-grade pipelines reduce them
The documented risks fall into two kinds: risks from wearing the device and risks from what it shows. The FDA lists neck pain from headset weight, plus content risks such as low-contrast images, display errors in the location or depth of anatomy, information overload, dizziness, fatigue and effects on vision. Its list of probable risks adds cybersickness, cybersecurity and privacy risks, distraction in the operating room, unknown effects in children and other vulnerable groups, and the chance of widening disparities in diagnosis and treatment.
In mental health, a systematic review of 73 VR and AR intervention studies found 7 that reported worsening clinical symptoms or a higher fall risk. The authors stress that the side-effect profile of clinical VR remains largely unknown. In stroke rehabilitation, a small number of users reported pain, headaches or feeling faint or dizzy, with no serious unwanted effects.
Hygiene is a practical risk for headsets shared between patients. Headsets shared between patients can spread pathogens between patients and staff, and no standard operating procedure for disinfecting them exists. One study tested isopropyl alcohol and alcohol-free quaternary ammonium wipes on porous and non-porous surfaces of the Meta Oculus Quest and Quest 2.
The cleared device builds several mitigations into its design. Sessions run 2 to 16 minutes (6 minutes on average) and are designed to minimise emotional distress and motion sickness. The programme is self-administered while seated. The software is locked to a proprietary headset. Adverse events have to be evaluated, and the warnings are on the label. In our view, most of what makes a pipeline “clinical-grade” is control: a fixed hardware and software pairing, short, dosed sessions, a known posture, a cleaning protocol, and a record of every session and adverse event. A headset bought off the shelf with homemade content has none of these by default.
Hardware, content and integration limits holding back clinical VR
Cost comes first. Headsets cost hundreds of dollars each, and most payers do not yet cover them. Equipment is only part of the bill: therapists also name a lack of equipment and a lack of training. The same study notes that older complaints about bulky headsets and poor graphics have given way to a more complex mix of individual and contextual factors.
Content is the second limit. A cleared therapy is a structured programme, in RelieVRx’s case 56 sessions over eight weeks, sequenced to deliver cognitive content alongside experiential practice. RelieVRx’s change control plan allows future hardware changes only without altering its intended use or therapeutic content.
Integration is the limit the evidence reviewed here says least about. We found no source in the material reviewed here that measures how often clinical VR systems connect to electronic health records or outcome registries, so treat what follows as judgement. If session counts, adherence, adverse events and patient-reported outcomes stay on the headset or in a vendor’s portal, the programme cannot produce the longitudinal data that payers and funding committees ask for. The reimbursement system makes the same point from the other direction: Category III codes exist to gather outcomes data, and CMS has asked what VR adds over a screen. Getting that data out of the device and into the clinical record is the most underrated engineering task in a clinical VR programme.
The deployment stack brings its own decisions. Where the pipeline also runs on-device AI inference on AMD hardware, our explainer on compiling for AMD AI Engines with MLIR AIE covers the toolchain.
The general challenges of virtual reality, and where VR earns its cost more broadly, are discussed separately. What is specific to healthcare is that every limit above sits next to the question a funder will ask at renewal: did patients get better, and can you show it? A programme that answers with session logs linked to outcomes is in a different position from one that answers with testimonials. Trial evidence for VR exposure therapy and in-home back-pain VR already exists. The missing piece is the data plumbing.
FAQ
What does VR stand for in medical settings?
VR stands for virtual reality: a headset-based, computer-generated environment used for therapy, training or rehabilitation. The FDA lists treatment areas for AR and VR together.
Do hospitals use VR?
Yes, though mostly in research and specialised settings rather than routine care. The FDA lists AR/VR use in surgery planning, intraoperative procedures, rehabilitation, pain management and mental health.
