E0693, Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eyeHCPCS/CPT
Prior Auth Required
At least one active policy explicitly requires prior authorization (high confidence)
ANTHEM-CG-DME-41, Ultraviolet Light Therapy Delivery Devices for Home Use
EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025
AMBETTER-CP.MP.107, Durable Medical Equipment and Orthotics and Prosthetics Guidelines
BCBSIL-DME101.000, Durable Medical Equipment (DME) Reference List
BCBSMT-DME101.000, Durable Medical Equipment (DME) Reference List
BCBSNM-DME101.000, Durable Medical Equipment (DME) Reference List
BCBSOK-DME101.000, Durable Medical Equipment (DME) Reference List
REGENCE-MED98, Targeted Phototherapy for the Treatment of Psoriasis
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