Does A4634 require prior authorization?

No, A4634 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for A4634?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`A4634`, Replacement bulb for therapeutic light box, tabletop model

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documentation of diagnosis: Member is diagnosed with bipolar disorder or recurrent major depression.
Documentation that member meets DSM-V criteria for a seasonal mood disorder: at least 2 years of seasonal depressive episodes which completely remit when daylight increases in the spring and which substantially outnumber any non-seasonal depressive episodes.

Documentation of home phototherapy trial: when criteria are met, Aetna covers rental of the high-intensity light unit for the first month to see if home phototherapy is effective in relieving the member's depression (implied requirement to document response during rental period).

Key Coverage Criteria

ICD-10 codes covered if selection criteria are met: F33.0 - F33.9 Major depression disorder, recurrent [seasonal affective disorder]
When criteria are met, Aetna covers rental of the high-intensity light unit for the first month to see if home phototherapy is effective in relieving the member's depression.
CPT code covered if selection criteria are met: 96900 Actinotherapy (ultraviolet light).
HCPCS codes covered if selection criteria are met: A4634 Replacement bulb for therapeutic light box, tabletop model; E0203 Therapeutic lightbox, minimum 10,000 lux, table top model.
Aetna considers a high-intensity light unit for light box therapy medically necessary durable medical equipment (DME) for members who have seasonal affective disorder (SAD) and meet both of the following criteria.
Member is diagnosed with bipolar disorder or recurrent major depression;

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`A4634`, Replacement bulb for therapeutic light box, tabletop model

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

A4634, Replacement bulb for therapeutic light box, tabletop model

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

`A4634`, Replacement bulb for therapeutic light box, tabletop model