CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

home_phototherapy_policy

This policy governs coverage for home-based phototherapy/ultraviolet light therapy devices (including PUVA/UVB) used to treat dermatologic conditions and specifies that home phototherapy is not covered due to insufficient evidence of safety and effectiveness compared with office-based treatment. It also lists billing HCPCS codes and which are not covered under Medicare Advantage and commercial products.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

Policyhome_phototherapy_policy

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJun 21, 2016

Next Review Date

Key ActionDeny claims for home phototherapy devices (E0692, E0693, E0694) because these therapies are considered a convenience and not medically necessary given insufficient evidence of safety/effectiveness.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes identified; policy continues to state home phototherapy is not covered due to insufficient evidence of safety and effectiveness compared with office-based treatment.

1HCPCS code listed as covered

3HCPCS codes listed as not covered

Coverage Summary & Determination

Scope: This policy governs coverage for home-based phototherapy/ultraviolet light therapy devices (including PUVA and UVB) used to treat dermatologic conditions and specifies that home phototherapy is not covered because evidence is insufficient to determine that home-based therapy is as safe or effective as office-based treatment. (Effective: 2016-06-21; Last review: 2021-05-19.)

Policy Statement / Coverage Determination

Phototherapy in the home for the treatment of dermatological conditions is not covered because evidence is insufficient to determine home-based therapy is as safe or effective as office-based treatment.

Home phototherapy not covered

Rationale 1: There is insufficient evidence to determine that home-based PUVA (ultraviolet light therapy) or any other home-based ultraviolet light for treating dermatological conditions is as safe or effective as office-based treatment.
Rationale 2: Use of home phototherapy is considered a convenience for the member and is therefore not covered.
Supporting evidence: Some trials (e.g., van Coevorden et al. 2004) showed comparable efficacy for specific home regimens, but the policy notes lack of validation and absence of comparisons to office-based PUVA; overall evaluations and monitoring needs make PUVA generally not recommended for home therapy.

Billing codes: HCPCS codes E0692, E0693, and E0694 for home phototherapy systems are listed as not covered; E0691 is listed as covered for certain plans.

See policy coverage code list for Medicare Advantage and Commercial Products.

Policy Metadata

SubjectHome phototherapy (home ultraviolet light therapy) for dermatologic conditions

StatusCURRENT

Effective Date2016-06-21

Last Review Date2021-05-19

PayerBlue Cross Blue Shield - Rhode Island

Policy IDhome_phototherapy_policy

Coverage StanceNot covered (home phototherapy considered a convenience; insufficient evidence of safety/effectiveness vs office-based)

Billing Codes

Medicare Advantage Plans and Commercial Products - CoveredHCPCSCovered

E0691

Ultraviolet light therapy system, includes bulbs/lamps, timer and eye protection; treatment area 2 sq ft or less

Medicare Advantage Plans and Commercial Products - Not CoveredHCPCSNot Covered

E0692	Ultraviolet light therapy system panel, includes bulbs, timer and eye protection, 4 ft lamps, panel
E0694	Ultraviolet multidirectional light therapy system in 6 ft cabinet; includes bulbs/lamps, timer, and eye protection
E0693	Ultraviolet light system panel, includes bulbs/lamps, timer and eye protection, 6 ft panel therapy

Actions for Claims and Billing

Denial Risk

Claims for home phototherapy devices

Claims for home phototherapy devices (home-based PUVA or other home ultraviolet light therapy) should be denied/not covered because the policy states these therapies are considered a convenience and not medically necessary given insufficient evidence of safety and effectiveness compared with office-based treatment.

E0692
E0693
E0694

Background & Evidence Summary

Background: Home phototherapy units emit high-intensity ultraviolet light on specific wavelengths for treatment of dermatologic diseases and are intended for home use. Some devices (for example, the Levia personal targeted phototherapy UVB device) received FDA 510(k) clearance for home treatment of psoriasis. Although trials such as an open-label RCT found that oral PUVA with a portable home unit produced comparable clinical improvement to hospital bath PUVA for chronic hand eczema, studies are limited, and no trials compared home-based PUVA with office-based PUVA. Because patients require regular assessment to monitor effectiveness and adverse effects during PUVA therapy, and given concerns about safety monitoring and insufficient evidence of equivalence to office-based treatment, home-based PUVA or other home ultraviolet light therapy is considered a convenience and is not covered.

Study	Summary
van Coevorden et al (2004)
Open-label randomized controlled trial (n=158) found oral PUVA with a portable home unit had comparable clinical efficacy to hospital-administered bath PUVA for chronic hand eczema, with lower travel costs and less time off work; authors noted results need validation by more research.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

Policyhome_phototherapy_policy

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJun 21, 2016

Next Review Date

SourceLink

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home_phototherapy_policy

Coverage Summary & Determination

Billing Codes

Actions for Claims and Billing

Background & Evidence Summary

Revision History