There is a wide range of medical policies among health insurance companies in their coverage of vitiligo treatments. While some companies cover the full range of FDA-approved treatments, others do not cover it at all, only cover certain treatments, or have limitations on coverage.
A recent study (Wiley library) surveyed 15 commercial health care insurers, 50 BlueCross & BlueShield plans, plus Medicare, Medicaid, and Veterans Affairs. Results indicate that of 17 organizations with regional or national coverage policies, 41% did not cover laser therapy and 56% did not cover UV phototherapy.
Most of private health insurance companies initially reject claims for reimbursement. However, with enough efforts they will eventually provide patients with coverage for UV phototherapy for vitiligo, as we show using a Medicare example here and a sample letter.
Medicare insurance stipulates that all covered expenses must be deemed medically necessary. UV light therapy is considered reasonable and necessary for patients that have not responded to other forms of treatment and meet coverage criteria.
However, Medicare coverage does not include UV light therapy if the main purpose of the therapy is to simply tan the skin or otherwise improve one’s appearance. The exception is if the treatment is prescribed for a “medically necessary reason” and a cosmetic benefit happens to be a side effect.
A “medical necessity” might arise in cases where an individual with vitiligo has been also diagnosed with mood disorders, like major depressive, bipolar, seasonal affective or persistent depressive disorder, - which is far too common among vitiligo patients. This is because mood disorders can be harmful to one’s mental and physical health, and in severe cases, can lead to suicidal actions. Another medical necessity is represented by the risk of a serious sunburn of a depigmented skin.
If UV light therapy is prescribed to treat e.g. seasonal affective disorder, it is likely that Medicare will require the patient to try other treatments first, including traditional prescription medications that treat mood disorders. Consequently, this cost will typically fall under Medicare Part A or B (hospital or outpatient procedures using durable medical equipment.) Home UVB therapy for vitiligo is still considered “investigational” and may not be not covered by Medicare, as well as laser phototherapy.
CODING AND BILLING
Medical billers use ICD (International Classification of Diseases) and CPT (Current Procedural Terminology) coding manuals as a guide for proper coding of each patient’s visit. The ICD codes describe patient complaints and the CPT codes report services provided. The CPT code set is also known as the HCPCS Level I codes for Medicare/Medicaid purposes.
The diagnosis coding for vitiligo remains straightforward under the earlier ICD-9 (709.01) and current ICD-10 (L80). However, there is no specific CPT code for light therapy for vitiligo. It may be reported using the CPT 96999, but the CPT codes for 96900-96910 for light box might also be used.
Patients can also ask for free insurance reimbursement assistance on the purchase of home UVB units from manufacturers based in USA or Canada.
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Though it is not always easy to treat vitiligo, there is much to be gained by clearly understanding the diagnosis, the future implications, treatment options and their outcomes.
Many people deal with vitiligo while remaining in the public eye, maintaining a positive outlook, and having a successful career.Copyright (C) Bodolóczki Júlia
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