Phototherapy is treatment for certain skin diseases that exposes the affected skin to ultraviolet light. Ultraviolet light (UVL) is light which is beyond the violet range in the spectrum. It consists of various subdivisions including long wave length ultraviolet light A (UVA) and shorter wave length ultraviolet light B (UVB). Since ultraviolet light therapy is not always performed in conjunction with a typical physician's office visit, it is separately reimbursable.

Description of Therapies

There are four basic approaches in the use of ultraviolet light (UVL) therapy which are discussed below. Payment may be made for services provided 2-3 times per week for eight weeks or a maximum of 30 treatments. Claims reporting more than 30 treatments should include documentation verifying medical necessity. The three recognized forms of ultraviolet light therapy include the following:

1. Actinotherapy, Ultraviolet Light B (UVB), Procedure Code 96900
   This standard form of phototherapy involves the use of ultraviolet light B without the concomitant use of photosensitizing agents. The purpose of the treatment is primarily to slow down the reproduction of skin cells in moderate-to-severe psoriasis. However, phototherapy has been proven effective in the management of other dermatological disease processes as well. Coverage for ultraviolet light therapy (UVB) is reimbursable when medically necessary for patients who have not responded to conservative treatment and billed with one of the following ICD-9 codes:
   
   • Psoriasis - 696.1
   • Atopic Dermatitis/Severe Eczema - 691.8
   • Pruritus of Renal Disease
   • Parapsoriasis - 696.2
   • Dyshidrotic Eczema - 705.81
   • Vitiligo - 709.01*, 103.2
   • Polymorphic Light Eruptions - 692.72
   • Lichen Planus - 697.0

     * Ultraviolet light therapy provided for patients with vitiligo is limited to those patients whose condition affects either:
     

   1. the skin of the face and/or neck area, or,
   2. other body areas in excess of 30% of skin surface.
      

2. Laser UVB, Procedure Code 96999
   UVB can also be delivered by laser therapy. The use of laser to treat skin disorders was developed to deliver a higher concentration of light to a more defined lesion thus sparing surrounding tissue from exposure to the ultraviolet light. Since the clinical trials in the United States have been small, scientific evidence has not demonstrated the efficacy of treating dermatological conditions with laser rather than traditional UVB. Therefore, laser UVB is considered experimental/investigational. A participating, preferred, or network provider can bill the member for the denied service. Procedure code 96999 should be used to report this service.

3. Psoralen and Ultraviolet Light A (PUVA), Procedure Codes 96912, 96913
   PUVA therapy involves the combined use of a photosensitizing drug and ultraviolet light. The drug is a psoralen called oxsoralen (methoxsalen) which can be taken orally or applied topically. It makes the skin more sensitive to ultraviolet light A (UVA). The psoralen-UVA combination slows down the process that causes psoriasis lesions. PUVA is recommended for individuals who have a disabling psoriasis that does not respond adequately to other treatments such as UVB or topical steroids. Oxsoralen is the only psoralen derivative eligible for treatment of psoriasis. Other psoralens do not have FDA approval; therefore, their use is considered investigational/experimental. Any service involving ultraviolet light in combination with a psoralen other than oxsoralen should be denied. In addition to the diagnoses that have been approved for UVB, PUVA is also an approved treatment for Mycosis Fungoides (Cutaneous T-cell Lymphoma), 202.1.

4. Goeckerman Regimen, Procedure Codes 96910, 96913
   The Goeckerman regimen consists of exposure of the affected skin surface to ultraviolet B in conjunction with topically applied chemicals, e.g., tars. Goeckerman therapy is approved for reimbursement in the treatment of:
   
   • Psoriasis - 696.1
   • Atopic Dermatitis/Severe Eczema - 691.8
   • Dyshidrotic Eczema - 705.81
     

Although evaluation and management services are periodically necessary to evaluate the patient's progress and response to therapy, they should not be routinely billed with ultraviolet light therapy. Evaluation and management services reported on the same date of service as ultraviolet light therapy are appropriate in the following circumstances:

• when therapy is provided during the initial evaluation of the patient's condition;
• during periodic assessment of the patient's response to therapy;
• if the patient's condition worsens;
• if a complication occurs, e.g., burns; or,
• if the patient has a new complaint.
  

Home phototherapy is appropriate for the following diagnoses:

• Severe psoriasis - 696.1
• Atopic Dermatitis/Severe Eczema - 691.8
• Pruritus of Renal Disease
  

• The patient's condition must comply with one of the eligible diagnoses listed above, must have a documented positive response to ultraviolet light and must be chronic in nature.
• The device must be ordered by the physician.
• The device must be approved by the Food and Drug Administration.
• The device must be appropriate for the body surface/area being treated.
  

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

PRN References

06/1999, Ultraviolet light therapy guidelines change
04/2001, Ultraviolet light therapy now eligible for dyshidrotic eczema
12/2001, Laser ultraviolet light B considered investigational

Topical Psoralen-ultraviolet A Therapy for Palmoplantar Dermatoses: Experience with 35 Consecutive Patients, Mayo Clinic Proc., Vol. 73, No. 5, 05/1998

308-nm Excimer Laser for the Treatment of Psoriasis, Archives of Dermatology, Vol. 136, 05/2000