These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.
Prior authorization is not applicable for full body cabinet (multidirectional) home ultraviolet B phototherapy devices (E0694).
- Full body cabinet (multidirectional) home ultraviolet B (UVB) phototherapy treatment devices (E0694) are not covered per Minnesota Health Care Program.
Full body cabinet (multidirectional) home ultraviolet B (UVB) phototherapy device. (E0694)
If available, codes for a procedure, device or diagnosis are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all inclusive.
Ultraviolet multidirectional light therapy system in six foot cabinet, includes bulbs/lamps, timer and eye protection
CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.
- MHCP Provider Manual-Ultraviolet Light Therapy Systems – Date 02-10-2012.