Phototherapy and phototherapy devices used in the treatment of SAD are considered experimental/investigational and not eligible for reimbursement. A participating, preferred, or network provider can bill the member for the denied service. According to the U.S. Food and Drug Administration (FDA), phototherapy devices require FDA approval. Currently, no phototherapy device has been approved for use in the treatment of SAD.

NOTE:

Total payments for a rental item may not exceed its allowable purchase price, except for those items identified as life sustaining DME. For information on continuous rental of life sustaining DME, see Medical Policy Bulletin E-38, Continuous Rental of Life Sustaining Durable Medical Equipment (DME).

Description

Phototherapy is the use of light in the treatment of a condition/disease. This therapy has been used in the treatment of seasonal affective disorder (SAD). SAD is defined as a history of depressive episodes that recur regularly at a particular time of year, typically winter. It is associated with decreases in ambient light exposure during the winter season. Most commonly, phototherapy treatment is in the form of white light at an intensity of 2500 lux or higher, equaling the light of a bright summer day.

Phototherapy devices, the light box (E0203) and the light visor, have been developed to deliver light in the intensity specified for the treatment of SAD. When using the light box, the patient is typically instructed to remain within a specified distance from the device for a certain length of time, usually from 30 minutes to several hours. This phototherapy treatment is given for a period of days to weeks, until a satisfactory anti-depressive response is attained. This treatment can be repeated in the case of relapse following initial treatment.

The light visor delivers an identical intensity of supplemental light for the same time period. However, this device allows the patient to move around and perform normal activity during the treatment period.

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.

Phototherapy for the Treatment of Seasonal Affective Disorder, Technologica, March 30, 1999

Phototherapy Light for the Treatment of Seasonal Affective Disorder, Medical Policy Reference Manual, Policy 1.01.04, 02/2004

Phototherapy Light for the Treatment of Seasonal Affective Disorder, Consortium Health Plans Inc., Policy 1.01.04, 09/1999

Practice Guideline for the Treatment of Patients with Major Depressive Disorder (Revision), American Psychiatric Association, Am J Psychiatry, April 1, 2000; 157(4 Suppl): 1-45

Depression and Its Relation to Light Deprivation, Psychoanal Rev, August 1, 2002; 89(4): 557-67

Complementary and Alternative Medical Approaches to Treating Depression in a Family Practice Setting, Clin Fam Pract, December 2002; 4(4): 873

Major Depression in Adults for Mental Health Care Providers, Institute for Clinical Systems Improvement (ICSI), September 2003; p. 49

Somatic Treatment for Depressive Illnesses in Children and Adolescents, Psychiatr Clin North Am, March 2004; 27(1): 113

Cognitive-Behavioral Therapy, Light Therapy, and Their Combination in Treating Seasonal Affective Disorder, J Affect Disord, June 1, 2004; 80(2-3): 273-83