E0692 — Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 4 foot panel
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- No documentation requirements are specified in the provided excerpt.
- Documentation of patient adherence and response to therapy (e.g., adherence logs from the device/app and clinical response notes).
- No documentation requirements are specified in the provided text.
- No documentation requirements specified in this document
Key Coverage Criteria
- Daavlin - 4 Series: Portable 4 foot panel
- Daavlin - M Series: Treatment of hands and/or feet
- UVB phototherapy devices are also available for home use.
- Lichen planus
- Morphea (localized scleroderma)
- Mycosis fungoides (a subtype of cutaneous T-cell lymphoma)
9 Active Policies
AMBETTER-CP.MP.107 — Durable Medical Equipment and Orthotics and Prosthetics Guidelines
HUMANA-ULTRAVIOLET-LIGHTLASER-THERAPY-FOR-SKIN-CONDITIONS-MA — Ultraviolet Light/Laser Therapy for Skin Conditions - Medicare Advantage
ANTHEM-CG-DME-41 — CG-DME-41 Ultraviolet Light Therapy Delivery Devices for Home Use
BCBSIL-DME101.000 — Durable Medical Equipment (DME) Reference List
Related Codes
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