VR Exposure Therapy and Health Insurance in Spain: Outlook

The US precedent: RelieVRx and Medicare

In November 2021, the US FDA authorized the RelieVRx device (formerly EaseVRx) for therapeutic use in chronic low back pain in adult patients. Two years later, in January 2024, the Centers for Medicare and Medicaid Services (CMS) issued a specific payment code for the device, incorporating it as a reimbursable benefit under certain clinical conditions.

This is a significant regulatory precedent: for the first time, a public health agency in a developed country recognizes a virtual reality device as a benefit with its own reimbursement rate within a health coverage program. Although the specific case is limited to chronic low back pain, it opens a path that will hardly remain exclusive to that indication in the medium term.

The VRET team believes the pace at which this precedent reaches Europe will vary by country. The United Kingdom, the Netherlands, and Germany, with mature healthcare and private insurance systems, are candidates to move first. Spain will likely follow with some delay, as has happened with other health technology innovations.

Spain's main insurers, one by one

Let's examine how the four insurers with the largest share of the Spanish private market currently approach clinical virtual reality. The information that follows is the best available at the time of writing and should be verified with the specific insurer before making operational decisions.

Adeslas. Coverage for clinical psychology is included in several plans, with specific per-session rates and per-episode authorizations. As of today, there is no differentiated benefit for VR exposure and no specific reimbursement rate. VR exposure sessions are billed under the general psychology session code.

Sanitas. A situation similar to Adeslas. Psychology coverage is included depending on the contracted plan, with no specific rate for virtual reality. Some in-network centers are exploring bilateral agreements to include VR exposure within the benefits schedule, but there is no systematic coverage movement.

Mapfre. General psychology coverage under the policy's terms. No differentiated recognition of VR exposure.

DKV. General psychology coverage. Some recent communications from the group point to interest in digital innovation for mental health, but no specific published rates.

Other insurers (Asisa, Caser, Generali, MGS, Cigna): an equivalent situation. Virtual reality does not appear as a differentiated benefit in their published provider directories.

Why there is no specific reimbursement rate yet

The fact that clinical virtual reality does not yet appear as a differentiated benefit in Spanish insurers' rate schedules is not, in general, due to a lack of evidence. Meta-analyses on VR exposure for specific phobias, social anxiety, and post-traumatic stress disorder are consistent and already form part of the established clinical literature.

The reasons are more operational. First, Spanish insurers move cautiously and tend to wait for the national public system or a reference European country to adopt a benefit before including it in their private plans.

Second, there is no clear standardization of 'what counts as' a VR exposure session: whether it includes assessment time, which devices qualify, which protocols are recognized. Without standardization, the reimbursement rate is difficult to build.

Third, the administrative burden of incorporating a new benefit with prior authorization is high if the expected volume of use is still low. Insurers wait until volume justifies the administrative cost of adding the benefit.

These three factors suggest that change will come, but probably not before three to five years on a widespread scale. These timeframes are approximate and depend on how the market evolves.

The likely regulatory path

The VRET team has developed a likely scenario for regulatory evolution in Spain, based on how other specialized benefits have historically been incorporated into private rate schedules.

Phase 1 (present). Indirect coverage. VR exposure sessions are billed under the general psychology session code, with no differentiation in the rate. This is the current situation.

Phase 2 (likely in 2-4 years). Coverage with prior authorization. The insurers that move first could introduce VR exposure as a benefit requiring specific prior authorization, where the clinician must justify the indication and the session's traceability. This would be compatible with differentiated rates.

Phase 3 (likely in 5-7 years). Widespread specific reimbursement rate. Once two or three insurers have paved the way and consolidated clinical data exists at the national level, the rest of the market will tend to incorporate differentiated rates to remain competitive in their provider offering.

Any timeframe estimate is approximate and depends on macro variables (European regulation, market evolution); it does not constitute a commitment or promise.

What clinics can do now

While the regulatory change materializes, there are three operational moves a private clinic in Spain can make now to position itself favorably when the change arrives.

First, document clinical traceability. Every VR exposure session should be recorded with basic clinical data: protocol followed, stimuli presented, reported anxiety levels (SUDS scale or equivalent), duration, clinician observations. This systematic traceability is what will make it possible to demonstrate value when an insurer opens a conversation about a differentiated rate.

Second, keep billing organized. Even though there is currently no differentiated rate, it's worth internally separating VR exposure sessions from ordinary sessions. This makes it easier to report volume and outcomes to the insurer's evaluator if the opportunity arises.

Third, participate in professional industry groups. Professional licensing boards and associations of private healthcare centers are the natural counterparts for insurers. If your practice is an active member of these bodies, you will have indirect influence over how future rates are designed.

How to talk with an insurance evaluator

If your practice has agreements with one or more insurers and you want to open a conversation about differentiated recognition of VR exposure, there is an approach that tends to work better than a direct request.

Start by presenting data. If you have used VRET for six to twelve months with patients referred by that insurer, you can prepare an anonymized aggregate report (no individual identification) showing: number of patients treated, diagnostic distribution, average number of sessions per episode, clinical closure indicators, and progression of the scales administered. The specific figures are illustrative and depend on your practice's actual volume.

Frame the conversation in terms of efficiency. An insurer moves faster if it perceives that a protocol can reduce the total number of authorized sessions per episode without compromising clinical outcomes. If your data suggests that efficiency, it is the best basis for negotiating differentiated recognition.

Avoid promotional language and commitments the practice cannot sustain. An insurer will immediately reject a provider that promises efficacy figures that cannot be verified. The honest approach is to present the observed data with clear disclaimers and let the evaluator draw their own conclusions.

The special case of occupational mutual insurance societies

Occupational mutual insurance societies (Fraternidad, Asepeyo, Umivale, and similar entities — Spain's employer-funded work-injury insurers) are a different player from traditional private insurers. They cover occupational contingencies and, in some cases, psychological care linked to workplace accidents or occupational illnesses.

For these mutual societies, the operational case for VR exposure fits clearly in scenarios such as post-traumatic anxiety after a workplace accident, fear of driving after a work-related traffic incident, or return to work after anxiety episodes related to occupational factors.

The conversation with a mutual society tends to be more direct than with a private insurer because the purpose of the coverage (return to the job) is aligned with the clinical efficiency VR exposure provides. However, the administrative processes are demanding, and the clinician must be prepared to manage specific reports.

What not to expect in the short term

To close with operational honesty, it is important to calibrate expectations. There are three things that will probably not happen in the Spanish market over the next two years.

There will not be massive, widespread coverage of VR exposure as a differentiated benefit in private provider directories. Movements will be selective, by insurer and by disorder.

There will not be differentiated rates that significantly raise fees above the ordinary session. Insurers tend to introduce new benefits with contained rates during the first years. Profitability will continue to depend, fundamentally, on the direct private-pay patient.

There will not be a regulatory change in the public healthcare system incorporating VR exposure into the service portfolio. The processes of Spain's National Health System are slow, and this move, if it happens, will come after a decade or more. Private clinics that want to capitalize on the change therefore have a window of several years to build their position.

This article is for informational purposes for psychology professionals. It is not clinical advice for any individual case and does not replace the judgment of the licensed psychologist in charge. VRET is professional clinical-support software, not a CE-marked medical device.