Phototherapy and Photochemotherapy (PUVA) for Skin Conditions

PUVA (psoralens + UVA) is considered medically necessary only for alopecia areata, chronic palmoplantar pustulosis, cutaneous T‑cell lymphoma (mycosis fungoides), cutaneous graft‑versus‑host disease, and eosinophilic folliculitis/other pruritic HIV eruptions, while UVA, narrow‑band UVB, UVB with coal tar (except for psoriasis), and use of petrolatum/emollients before UV are excluded as experimental/investigational for indications not specifically listed. Key requirement: PUVA is covered only after conventional therapies have failed; all other UV modalities are limited to the listed indications or are investigational.

"Phototherapy with UVA for: Pityriasis lichenoides"

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