Does Medicare Cover Light Therapy for Psoriasis?
Fair Square Medicare

Does Medicare Cover Light Therapy for Psoriasis?

Acute psoriasis on elbows is an autoimmune incurable dermatological skin disease stock photo

By Daniel Petkevich

Jan 17, 2023

There are some stipulations to getting coverage

If you have psoriasis, you know it's difficult to find the right treatment that works to manage your flare-ups. For those with moderate to severe plaque psoriasis, finding the right treatment that works for your skin and your budget can mean the difference between carrying on with your life and debilitating pain. Light therapy is one of the many treatment options that can be covered by Medicare. Read on to see if it's the right option for you.

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Overview of psoriasis and its symptoms

Psoriasis is a chronic skin condition that causes red, scaly patches and thick, silvery scales on the skin. Symptoms vary from person to person but can include itching, burning or soreness. Psoriasis can also cause psoriatic arthritis—a type of joint pain and swelling.

What Medicare covers for psoriasis treatment

Medicare covers psoriasis treatment in some instances. If light therapy is considered medically necessary for psoriasis, Medicare may help cover the cost of your psoriasis treatment. In addition to light therapy, Medicare also covers other psoriasis treatments, such as topical medications, photochemotherapy and biologics.

If you’re a Medicare beneficiary, be sure to talk to your doctor about psoriasis treatments that Medicare might cover. Your doctor can help you understand which psoriasis treatments may be best for you. With the right psoriasis treatment plan, you may see an improvement in your psoriasis symptoms.

Types of psoriasis treatments that are typically covered by Medicare

Light therapy (phototherapy) is a psoriasis treatment that exposes your skin to ultraviolet light in small doses. Phototherapy helps treat psoriasis by slowing the growth of affected skin cells, reducing redness and scaling, and improving psoriasis symptoms. Medicare may cover psoralen derivative drug in combination with ultraviolet A light, also known as PUVA, under the following conditions according to the CMS:

"PUVA therapy is covered for treatment of intractable, disabling psoriasis, but only after the psoriasis has not responded to more conventional treatment. The Medicare Administrative Contractor should document this before paying for PUVA therapy."

In addition to light therapy, Medicare may cover other psoriasis treatments. Topical medications, such as creams and ointments applied directly to the skin, can help reduce psoriasis symptoms and slow down the growth of psoriatic cells. Photochemotherapy (PUVA) combines an oral psoralen derivative drug with ultraviolet A light to help treat psoriasis. Medicare may also cover biologics, which are injected medications that target specific areas of the immune system to reduce psoriasis flare-ups.

How to determine if light therapy is medically necessary for psoriasis treatment

Your doctor will work with you to determine if light therapy is medically necessary for psoriasis treatment. They may consider the following criteria:

  • The psoriasis has not responded to other treatments

  • You’re receiving regular psoriasis care from a physician

  • You have psoriatic arthritis or psoriasis in areas that are hard to reach

  • You’re experiencing a psoriasis flare up or worsening of psoriasis symptoms

  • The psoriasis has caused physical, mental and emotional distress

If you meet one or more of these criteria, your doctor may determine that light therapy is medically necessary for psoriasis treatment.

Tips on how to document improvement when seeking coverage from Medicare

To determine if Medicare covers psoriasis treatment, your doctor will need to document any improvements in your psoriasis symptoms. Here are a few tips on how to document improvement when seeking coverage from Medicare:

  • Take pictures before and after receiving treatment

  • Keep track of symptoms in a diary

  • Report flare-ups or worsening of symptoms to your doctor

  • Track side effects from treatments and report them to your doctor

  • Provide feedback on treatments, including how effective they have been in managing your symptoms

By documenting your symptoms and improvements, your doctor can help determine if your treatment is medically necessary. Medicare may then cover the cost of psoriasis light therapy deemed medically necessary.

Other psoriasis treatments that Medicare might cover

In addition to light therapy, Medicare may cover other psoriasis treatments. These treatments include topical medications, photochemotherapy and biologics. Topical medications are creams and ointments that are applied directly to your psoriasis patches, such as Ilumya. Photochemotherapy (PUVA) combines an oral psoralen derivative drug with ultraviolet A light to help treat psoriasis. Biologics are injected medications that target specific areas of the immune system to reduce flare-ups.

If you’re a Medicare beneficiary, be sure to talk to your doctor about psoriasis treatments that might be covered by Medicare.

Conclusion

If you have psoriasis and are a Medicare beneficiary, be sure to talk to your doctor about psoriasis treatments that might be covered by Medicare. With the right psoriasis treatment plan, you may see an improvement in your symptoms. Your doctor can help you understand which psoriasis treatments may be best for you and how to document any improvements when seeking coverage from Medicare. Remember, talking with your doctor is necessary, as this content is for informational purposes only. Our team of experts is here to help with all your Medicare questions. Don't hesitate to reach out to Fair Square Medicare.

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