Description
Home ultraviolet light box/cabinets or ultraviolet lamps are durable medical equipment that typically contain multiple fluorescent lights that emit high intensity, ultraviolet light (UVB). These boxes/lamps have been used for various reasons, including treatment of psoriasis, eczema, photodermatoses, pruritus, pityriasis, lichen planus, parapsoriasis and pruritic eruptions of HIV infection, vitiligo, cutaneous T-cell lymphoma (CTCL)/mycosis fungoides and acne.

Policy
Ultraviolet light therapy in the home setting is considered MEDICALLY NECESSARY when the medical criteria and guidelines shown below are met:

Ultraviolet light therapy in the home is considered MEDICALLY NECESSARY when all of the following criteria are met:

• Patient has a diagnosis of extensive and refractory psoriasis, atopic dermatitis, eczema, cutaneous T-cell lymphoma (CTCL)/mycosis fungoides, vitiligo or hepatic or renal failure-associated pruritus. 
• Extensive and refractory involvement of the palms or soles with psoriasis would be considered sufficient for coverage.
• As an alternative to biologic, therapies and JAK inhibitors considered to treat psoriasis.
• Initially, the patient requires UV light treatments at least three times per week.

Ultraviolet light therapy in the home is considered NOT MEDICALLY NECESSARY when:

• The patient does not meet all of the qualifying clinical diagnoses or requirements.
• It is being prescribed solely for the member’s convenience.
• It is for cosmetic purposes, such as tanning.

Rationale 
Extensive disease is defined as more than 5% of the body surface area affected.

Refractory disease is defined as failure of adequate trials of topical regimens such as steroids or coal/tar preparations.

Koek and colleagues conducted a randomized, controlled, single-blind trial comparing office-based UVB treatment to home therapy for individuals with plaque or guttate psoriasis (PLUTO). This study involved 196 subjects who were evaluated through the initial therapy, with the first 105 subjects followed for an additional 12 months post-treatment. The authors reported that both treatments provided significant improvement from baseline, with home therapy being noninferior to office-based treatment as measured by the psoriasis area and severity index (PASI) and the self-administered psoriasis area and severity index (SAPASI). No differences between groups were reported with regard to total cumulative radiation dose or short-term side effects.

A second review of the PLUTO trial assessed the costs and cost-effectiveness of UVB home light therapy compared to outpatient UVB therapy for psoriasis. The results showed that home UVB phototherapy is not more expensive than therapy received in the outpatient setting, and patients expressed a preference for home treatment.

According to the American Academy of Dermatology Guidelines of Care for the Management of Psoriasis and Psoriatic Arthritis, home UVB therapy is a safe and effective treatment option for many patients; however, patients must be educated as to the potential long-term side effects of UVB — including an increased risk of skin cancer and premature aging — and protect their eyes by using goggles to decrease the risk of UVB-related cataracts that could form from prolonged exposure.

Prior to providing a prescription for home UBV therapy, patients should demonstrate improvement with initial UVB treatments in the provider’s office or symptom improvement with sun exposure.

References 

1. Plan Consultant - 3/96
2. Plan Medical Director - 3/99
3. Medical Policy Advisory Group - 10/99
4. Specialty Matched Consultant Advisory Panel - 2/2001
5. Ramsay DL, Lish KM, Yalwitz CB, et al. Ultraviolet-B phototherapy for early-stage cutaneous T-cell lymphoma. Arch Dermatol. 1992 Jul;128(7):931-3.
6. Sjovall P, Christensen OB. Treatment of chronic hand eczema with UV-B Handylux in the clinic and at home. Contact Dermatitis. 1994 Jul;31(1):5-8.
7. Feldman SR, Clark A, Reboussin DM, et al. An assessment of potential problems of home phototherapy treatment of psoriasis. Cutis. 1996 Jul;58(1):71-3.
8. Grundmann-Kollmann M, Behrens S, Poda M, et al. Phototherapy for atopic eczema with narrow-band UVB. J Am Acad Dermatol. 1999 Jun;40(6 Pt 1):995-7.
9. Specialty Matched Consultant Advisory Panel - 3/2003
10. ECRI Target Report #843 (2003, March) Home phototherapy for treatment of psoriasis. Retrieved on November 19, 2004 from tap://www.target.ecri.org/summary/detail.aspx?doc_id=1754&q=home+treatment+of+psoriasis&anm
11. Specialty Matched Consultant Advisory Panel - 2/11/2005.
12. Specialty Matched Consultant Advisory Panel - 4/27/2007
13. Koek MB, Buskens E, van Weelden H, Steegmans PH, Bruijnzeel-Koomen CA, Sigurdsson V. Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study). BMJ. 2009 May 7;338:b1542. doi: 10.1136/bmj.b1542. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2857750/?tool=pubmed
14. Menter A, Korman NJ, Elmets CA et al. American Academy of Dermatology: Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy 2010. Retrieved from http://www.guideline.gov/content.aspx?id=15651&search=american+academy+of+dermatology
15. Medical Director review 4/2012
16. Specialty Matched Consultant Advisory Panel review 2/2013
17. Koek MB, Sigurdsson V, van Weelden H, Steegmans PH, Bruijnzeel-Koomen CA, Buskens E. Cost effectiveness of home ultraviolet B phototherapy for psoriasis: economic evaluation of a randomised controlled trial (PLUTO study). BMJ. 2010 Apr 20;340:c1490. doi: 10.1136/bmj.c1490. Retrieved from http://www.bmj.com/content/340/bmj.c1490?view=long&pmid=20406865
18. Nolan BV, Yentzer BA, Feldman SR. A review of home phototherapy for psoriasis. Dermatol Online J. 2010 Feb 15;16(2):1. Retrieved fromhttp://dermatology.cdlib.org/1602/reviews/home_pt/feldman.html
19. Rajpara AN, O'Neill JL, Nolan BV, Yentzer BA, Feldman SR. Review of home phototherapy. Dermatol Online J. 2010 Dec 15;16(12):2. Retrieved from http://dermatology.cdlib.org/1612/2_reviews/2_10-00282/rajpara.html
20. Medical Director review 6/2013
21. Wang H, Yosipovitch G. New insights into the pathophysiology and treatment of chronic itch in patients with end-stage renal disease, chronic liver disease and lymphoma. Int J Dermatol. 2010 January; 49(1): 1–11.
22. Specialty Matched Consultant Advisory Panel review 1/2014
23. Medical Director review 1/2014
24. Specialty Matched Consultant Advisory Panel review 1/2015
25. Medical Director review 1/2015
26. Specialty Matched Consultant Advisory Panel review 1/2016
27. Medical Director review 1/2016
28. Bhutani T, Liao W. A practical approach to home UVB phototherapy for the treatment of generalized psoriasis. Pract Dermatol. 2010;7(2):31–35. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151182/

Coding Section

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each Policy. They may not be all-inclusive. 

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross Blue Shield Association technology assessment program (TEC) and other nonaffiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology © American Medical Association. All Rights Reserved" 

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