Seasonal Affective Disorder (SAD) Lights

Revised: January 25, 2024

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Authorization

· Billing

Overview

Therapeutic light boxes are used for treatment of seasonal affective disorder (SAD). This disorder is defined as a history of recurrent major depressive episodes during a particular time of the year, typically winter.

Eligible Providers

The following providers may provide SAD lights and related supplies:

· Federally qualified health centers

· Home health agencies

· Indian Health Services

· Medical suppliers

· Pharmacies

· Rural health clinics

TPL and Medicare

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

Eligible Members

SAD lights are covered for eligible MHCP members with a history of winter depressive episodes with seasonal onset that substantially outnumber any nonseasonal depressive episodes. Eligible diagnoses include:

· SAD

· Bipolar disorder

· Recurrent major depression

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 or rental of the light box and may not be separately billed. Replacement light bulbs are covered.

Refer to the Medical Supply Coverage Guide (PDF) for information about coverage and limits for supplies and equipment.

Therapeutic light boxes are covered when referred by an MHCP enrolled mental health practitioner.

Noncovered Services

Therapeutic light boxes are not covered when prescribed for:

· Conditions other than SAD, bipolar disorder, or recurrent major depression as there is no proven medical benefit for other indications

· Members 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 mental health practitioner

· A written diagnosis of SAD, 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

Providers are responsible to coordinate services. Review MHCP Billing Policy for general billing requirements and guidance when submitting claims.

Bill SAD lights and related supplies using the MN–ITS (837P). Refer to the Billing for Durable Medical Equipment, Medical Supplies, Prosthetic and Orthotics, and Augmentative Devices MN–ITS user guide for billing instructions.

Bill using the correct HCPCS code and the modifier NU or RR as noted on the authorization.

Refer to the Billing and Documentation section on the Equipment and Supplies section of the MHCP Provider Manual for additional information.