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Minnesota Department of Human Services Provider Manual
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SAD Lights

Revised: 08-01-2011

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Covered Services
  • Noncovered Services
  • Authorization
  • Billing
  • Overview

    Therapeutic light boxes are used for treatment of Seasonal Affective Disorder (SAD).

    Eligible Providers

    The following providers may provide SAD Lights and related supplies:

  • • Federally Qualified Health Center
  • • Home health agencies
  • • Indian Health Services
  • • Medical suppliers
  • • Pharmacies
  • • Rural Health Clinic
  • TPL and Medicare

    Providers must meet any provider criteria, including accreditation, for third party insurance in order to assist recipients for whom MHCP is not the primary payer.

    Eligible Recipients

    SAD lights are covered for eligible MHCP recipients with a history of winter depressive episodes with seasonal onsets which substantially outnumber any non-seasonal depressive episodes.

    Covered Services

    Codes: E0203, A4634

    Only tabletop therapeutic light boxes approved by the Food and Drug Administration (FDA) are covered. The light bulb is included in the initial purchase/rental of the light box and may not be separately billed. Replacement light bulbs are covered.

    Therapeutic light boxes are covered when prescribed by an MHCP enrollable mental health practitioner.

    Noncovered Services

    Therapeutic light boxes prescribed for:

  • • Conditions other than SAD as there is no proven medical benefit for other indications
  • • Recipients in nursing facilities or intermediate care facilities for developmentally disabled
  • Authorization

    Authorization is always required for purchase or rental of a SAD light box. All authorization requests must include:

  • • Credentials of the prescribing mental health practitioner
  • • A written diagnosis of bipolar disorder or recurrent major depression
  • • Summary of at least two consecutive years of seasonal depressive episodes with spring remission, including:
  • • Statement detailing depressive symptoms
  • • Month and year of onset and remission of depressive episodes
  • • Dates of any other depressive episodes
  • • Evidence of a positive response to light therapy, if available
  • • Summary of recipient’s ability and willingness to do the light therapy
  • • Summary of recipient’s compliance with other mental health treatment regimens
  • Submit authorization request and required documentation to the authorization medical review agent.

    Billing

    When billing with an approved authorization:

  • • Use MN–ITS 837P Professional
  • • Refer to the MN–ITS User Guide for DME, Medical Supplies, Prosthetic and Orthotic Services for detailed instructions
  • • Use the correct HCPCS code and the modifier NU or RR as noted on the authorization
  • Refer to the Billing section on the main Equipment & Supplies page and the Detailed Written Orders section for additional information.

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    Updated: 2/19/15 1:45 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 2/19/15 1:45 PM