Millions of Medicare beneficiaries with psoriasis wonder if their painful condition qualifies for coverage—but there’s a specific requirement for PUVA therapy that most people don’t know about, and it could determine whether you pay thousands out-of-pocket.
Key Takeaways:
- Medicare Parts A and B, along with Medicare Advantage plans, cover ultraviolet light therapy for psoriasis and other skin conditions when deemed medically necessary by a healthcare provider.
- Coverage requires a proper diagnosis, doctor’s prescription, and treatment at an approved Medicare provider or facility.
- Home UV light therapy units are covered as durable medical equipment under Part B when medically necessary, with Medicare paying 80% after the deductible.
- PUVA therapy requires documented failure of conventional treatments before Medicare will approve coverage.
- Treatment costs and coverage specifics vary depending on whether the therapy is provided in-office, at a hospital, or through prescribed home equipment.
Ultraviolet light therapy offers hope for millions of Americans struggling with chronic skin conditions like psoriasis. For Medicare beneficiaries dealing with these challenging conditions, understanding coverage options can make the difference between affordable treatment and overwhelming medical bills.
Medicare Covers UV Light Therapy for Medically Necessary Treatment
Medicare recognizes ultraviolet light therapy as a legitimate medical treatment for specific skin conditions, particularly psoriasis. Both Original Medicare (Parts A and B) and Medicare Advantage plans provide coverage when the therapy meets medical necessity requirements. The key factor determining coverage lies in having a proper diagnosis from a healthcare provider who deems the treatment necessary for managing the patient’s condition.
Medical necessity means the treatment must be reasonable and necessary for diagnosing or treating an illness or injury. For UV light therapy, this typically involves documented skin conditions that have not responded adequately to other treatments or where phototherapy represents the most appropriate first-line treatment option.
When Medicare Will Pay for Light Therapy
Medicare’s coverage for UV light therapy depends on meeting three requirements that ensure the treatment is both appropriate and necessary for the patient’s medical condition.
1. Required psoriasis diagnosis and doctor’s order
Coverage begins with a confirmed diagnosis of psoriasis or another qualifying skin condition from a Medicare-accepting healthcare provider. The physician must document the condition’s severity and determine that UV light therapy represents an appropriate treatment option. This documentation becomes part of the medical record that justifies the treatment’s necessity.
2. Medical necessity determination
Healthcare providers must demonstrate that UV light therapy is medically necessary for treating the specific condition. Medicare.org provides detailed information about coverage requirements and can help beneficiaries understand their options. This determination often involves showing that the condition significantly impacts the patient’s quality of life or poses health risks without treatment.
3. Treatment must be at approved provider
All UV light therapy sessions must occur at Medicare-approved facilities or be prescribed by providers who accept Medicare assignment. This ensures that the treatment meets Medicare’s quality standards and that billing follows proper procedures. Patients should verify their provider’s Medicare participation before beginning treatment.
Where You Can Receive Covered Treatment
Medicare coverage for UV light therapy varies depending on the treatment location, with different parts of Medicare applying based on whether the therapy occurs in an inpatient or outpatient setting.
Part A covers hospital and skilled facility treatment
When UV light therapy is administered during a hospital stay or at a skilled nursing facility, Medicare Part A provides coverage. This typically applies when the light therapy is part of a broader treatment plan requiring inpatient care. Patients pay the Part A deductible of $1,676 for 2025 per benefit period, after which Medicare covers the treatment costs during that benefit period.
Part B covers provider office treatment and prescribed home units
Most UV light therapy occurs in outpatient settings, making it eligible for Medicare Part B coverage. This includes treatments at dermatology offices, outpatient clinics, and prescribed home therapy units. After meeting the annual Part B deductible of $257 for 2025, patients pay 20% of the Medicare-approved amount for services.
Home Light Therapy Equipment Under Medicare Part B
Home-based UV light therapy offers convenience and potentially better treatment adherence for patients with chronic skin conditions. Medicare recognizes this benefit and provides coverage under specific conditions.
Covered as durable medical equipment with provider’s order
Home UV light therapy units qualify as durable medical equipment (DME) under Medicare Part B when prescribed by a healthcare provider and meet medical necessity criteria. The equipment must meet Medicare’s DME criteria, including being reusable, serving a medical purpose, and being appropriate for home use. The prescribing physician must document why home therapy is medically necessary and appropriate for the patient’s condition.
80% coverage after $257 deductible, you pay 20%
Once the annual Part B deductible is met, Medicare pays 80% of the approved amount for home UV light therapy equipment. Patients remain responsible for the remaining 20% coinsurance. The total cost depends on the type and complexity of the prescribed equipment, ranging from handheld devices to full-body treatment units.
PUVA Therapy Coverage Requires Failed Conventional Treatment
Psoralen plus Ultraviolet A (PUVA) therapy represents a more intensive treatment approach that combines medication with UV light exposure. Medicare’s coverage requirements for PUVA therapy are more stringent than standard phototherapy.
Only for intractable, disabling psoriasis
PUVA therapy coverage applies to cases of severe, intractable psoriasis that significantly disables the patient and has not responded to conventional treatments. The condition must be resistant to standard therapies and substantially impact the patient’s daily functioning. Healthcare providers must document the severity and disabling nature of the psoriasis to justify PUVA therapy coverage.
Medicare contractor must document treatment failures
Before approving PUVA therapy, Medicare requires documentation that conventional treatments have failed or proven inadequate. This includes evidence of unsuccessful attempts with topical medications, standard UV therapy, or other appropriate first-line treatments. The Medicare contractor reviews this documentation to ensure PUVA therapy represents a necessary step-up in treatment intensity.
Medicare Advantage Plans Must Cover Same Services
Medicare Advantage plans operate under federal requirements that ensure beneficiaries receive at least the same coverage as Original Medicare for medically necessary services, including UV light therapy.
Required to match Original Medicare coverage
All Medicare Advantage plans must provide coverage for UV light therapy that equals or exceeds Original Medicare’s coverage standards. This means that if Original Medicare covers a specific type of phototherapy for a qualifying condition, Medicare Advantage plans cannot deny coverage for the same service when it meets medical necessity requirements.
Out-of-pocket costs and suppliers may vary
While coverage requirements remain consistent, Medicare Advantage plans may have different cost structures and preferred provider networks. Some plans offer lower copayments for certain services, while others may require higher out-of-pocket costs. Additionally, plans may have specific networks of approved DME suppliers for home therapy equipment, potentially affecting where patients can obtain covered devices.
Get Your Doctor’s Order to Start Medicare-Covered Light Therapy
Starting Medicare-covered UV light therapy begins with a thorough evaluation by a qualified healthcare provider who can assess the condition, determine medical necessity, and provide the required documentation for coverage approval.
The process typically involves a dermatological examination, review of previous treatments, and discussion of treatment goals and expectations. Providers must document the specific type of UV therapy recommended, the treatment schedule, and the expected duration of therapy. This documentation supports the medical necessity determination and ensures proper billing to Medicare.
Patients should work closely with their healthcare team to understand their treatment options, expected outcomes, and any potential side effects or precautions associated with UV light therapy. Regular follow-up appointments help monitor treatment progress and make necessary adjustments to the therapy plan.