Does Medicare Cover Light Therapy for Psoriasis?

About

Medicare 101

Current Clients

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.

Stay Up to Date on Medicare!

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

Stay Up to Date on Medicare!

Your Medicare One-Stop-Shop

Your guide to Medicare Parts A & B, Medicare Advantage, and Medigap. 100% free.

Get the Fair Square Bulletin

Medicare savings tips, helpful guides, and more.

888-572-6033

[email protected]

About

Medicare 101

Current Clients

Medicare Supplement Plans

Medicare Advantage Plans

Fair Square 2023

•

Notice of Privacy Practices

Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2022 Help Button Inc

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

MULTIPLAN_FairSquareMedicare_01062022_M

Does Medicare Cover Light Therapy for Psoriasis?

There are some stipulations to getting coverage

Stay Up to Date on Medicare!

Overview of psoriasis and its symptoms

What Medicare covers for psoriasis treatment

Types of psoriasis treatments that are typically covered by Medicare

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

Tips on how to document improvement when seeking coverage from Medicare

Other psoriasis treatments that Medicare might cover

Conclusion

Stay Up to Date on Medicare!

Recommended Articles

More of our articles

Your Medicare One-Stop-Shop

About

Medicare 101

Current Clients

Medicare Supplement Plans

Medicare Advantage Plans