CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Phototherapy in the Home for the Treatment of Dermatological Conditions

This policy governs coverage of home-based ultraviolet phototherapy devices (e.g., UVB, PUVA) for treatment of dermatologic conditions for Blue Cross Blue Shield - Rhode Island Medicare Advantage and commercial products.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyPhototherapy in the Home for the Treatment of Dermatological Conditions

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJun 21, 2016

Next Review DateN/A

Key ActionCheck the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement to confirm applicable non-covered benefits and coverage details.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

0Covered home phototherapy indications (per policy)

4HCPCS device codes listed as not covered

2016-06-21Effective date

2024-02-07Policy last reviewed

Coverage Determination — Home Phototherapy

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Coverage determination

Phototherapy in the home for the treatment of dermatological conditions is considered:

ALL of the following

Home-based phototherapy (including home-based PUVA or other home-based ultraviolet light therapies) is not covered because the evidence is insufficient to determine that it is as safe or effective as office-based treatment.
Use of home phototherapy is considered a convenience for the member and therefore non-covered.

Policy dates: effective 2016-06-21; last review 2024-02-07

Relevant Billing Codes

Not covered HCPCS - home ultraviolet light therapy systemsHCPCSNot Covered

E0691	Ultraviolet light therapy system, includes bulbs, timer and eye protection; treatment area 2 sq ft or less
E0692	Ultraviolet light therapy system panel, includes bulbs, timer and eye protection, 4 ft panel
E0693	Ultraviolet light panel, includes bulbs/lamps, timer and eye protection, 6 ft panel therapy system
E0694	Ultraviolet multidirectional light therapy system in 6 ft cabinet; includes bulbs/lamps, timer, and eye protection

What Providers Need to Know

Documentation Required

Refer to benefit booklet for coverage details

Benefits may vary between groups and contracts; providers should check the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable non-covered benefits/coverage.

Denial Risk

Claim denial for home phototherapy devices

Claims for home-based phototherapy devices are not covered and may be denied.

E0691
E0692
E0693
E0694

Clinical and Administrative Context

Home phototherapy devices have been cleared by the U.S. Food and Drug Administration for some uses (for example, a targeted UVB device was cleared for home treatment of psoriasis), and these units are designed solely for medical treatment of skin diseases using high-intensity ultraviolet light on specific wavelengths.

Published trials and reviews report mixed findings: some randomized trials (for example, an open-label trial of oral PUVA with a portable home unit for chronic hand eczema) showed clinically comparable efficacy to hospital-administered PUVA for that condition, but overall evidence is insufficient to establish that home-based PUVA or other home ultraviolet therapies are as safe and effective as office-based treatment.

Because PUVA requires regular assessment to monitor effectiveness and detect adverse effects (including the risk of skin cancer), PUVA is generally not recommended for home use; office-based PUVA is preferred due to the need for monitoring and assessment for adverse effects including skin cancer risk.