Reimbursement

BILLING GUIDELINESClick Here

BILLING CODES Click Here

LETTER OF MEDICAL NECESSITYClick Here

Billing Guidelines

Two Options:

Option One:  Private Pay – Cash Reimbursement

If a patient does not have health insurance coverage, or if this is not a covered benefit under their current insurance plan, then a private pay or cash program is recommended. Since the average price of the units are under typically under $275.00, patients will find it to be an affordable option.

Option Two: Insurance Reimbursement

Most major insurance companies now authorize or reimburse the purchase of light therapy equipment for Seasonal Affective Disorder (SAD).

The following items are recommended for a person to submit to their insurance company:

1)  Prescription from your psychiatrist or general practitioner

2)  Invoice from Northern Light Technologies, Inc. for the light therapy device

3)  Letter of Medical Necessity (See Example Letter)

4)  Your own cover letter to the insurance company to include all pertinent member information: policy number; referring physician; and his/her number; date of service; and invoice for light therapy device

5)  Additional resources to submit include Abstracts from Professional Journals.

Disclaimer:

This Information is a general reference and is intended to assist the physician or provider in obtaining reimbursement for health care services. It is not intended to increase or maximize payment by any payor. Because coverage policies and coding change frequently, it is recommended you check with your local carrier frequently.  This is for informational purposes only, and nothing herein shall be construed as a statement, promise or guarantee regarding levels of reimbursement, payment or charge.

Furthermore, all codes provided herein are for information purposes only, and shall not be construed as a statement, promise or guarantee that these codes are accurate or reimbursement will be received. The ultimate responsibility for correct coding lies with the physician or provider.

THIS INFORMATION IS PROVIDED WITHOUT WARRANTY OF ANY KIND, EXPRESS OR IMPLIED.

Billing Codes for Light Therapy

CPT Code: 96900

HCPCS Code:

E0203:                          Therapeutic lightbox, 10,000 lux tabletop model

A4634:                          Replacement bulb for therapeutic lightbox, tabletop model

ICD-9 Diagnosis Code:

296.00 – 296.99              Affective psychosis

300.4                            Neurotic depression

301.10-301.13                Affective personality disorder

311                              Depressive disorder, not elsewhere classified

Code # and Diagnosis

DSM IV-296.3X –           Major Depression, Recurrent

DSM IV-296.4X –           Bipolar Disorder, most recent episode-Manic

DSM IV-296.5X –           Bipolar Disorder, Depressed

DSM IV-296.6X –           Bipolar Disorder, Mixed

DSM IV-296.8 –             Bipolar Disorder, NOS

DSM IV – 296.90 –        Mood Disorder, NOS: Seasonal Affective Disorder

DSM IV-311.00 –           Depressive Disorder, NOS

These procedures conform to April 1993 U.S. Public Health Service-Agency for Health Care Policy and research guidelines for management of this disorder.

AHCPR93-0551-Depress: Guideline Vol. 2; AHCPR93-0553-Depress: Patient Guide

 

Letter of Medical Necessity (Example)

This letter is for the doctor/medical professional to fill out. It describes the symptoms and proper diagnosis for SAD. It also describes the cost effectiveness over conventional antidepressant medication.

To whom it may concern,

This is to certify that _____________________________________________has been a patient of mine since_________________, 20____.

I have treated him/her for recurrent major depressions (DSM-IV 296.3), with a seasonal pattern. This condition, also known as Seasonal Affective Disorder (SAD), has been shown in many studies in the United States and elsewhere in the world to respond to treatment with bright environmental light (light therapy).

Light therapy is no longer considered experimental, but is a mainstream type

of psychiatric treatment, described in:  The Task Force Report of the American Psychiatric Association: Treatment of Psychiatric Disorders, Vol. 3, pages 1890-1896, APA Press, 1989.

In order to administer light therapy adequately, a quality light box, such as those manufactured by the Northern Light Technologies Company is required (see attached invoice).

Although a light box is an expensive piece of equipment, the experience of clinicians who have used it for many patients indicates that it saves a great deal of money in the long run, by reducing the number of doctors’ visits and laboratory investigations of persistent symptoms, as well as the indirect costs of lost productivity.

I contend that in _____________________________’s case the use of the light boxes from Northern Light Technologies, Inc. should be regarded not only as a medical necessity, to be used in preference to (or in addition to) other forms of treatment, but also as a means of reducing his/her overall medical costs.

Sincerely,