Issue 2005-4, April 2005

Ultraviolet Light A Therapy

Ultraviolet Light A therapy (PUVA) may be used to treat Mycosis Fungoides/Sezary Syndrome. PUVA is covered by Medicare for the treatment of Mycosis Fungoides when the documentation supports that the service is medically necessary.

The documentation required to support the medical necessity must include, but is not limited to, the following:

1. ICD-9-CM codes supporting the need for the service;
2. The initial evaluation and any reevaluations. The documentation should:

1. Give a clear description of the lesion(s); indicate whether the lesions involve patches, plaques, vesiculobullae, generalized erythroderma, hypopigmentation, fungating ulcers, tumors, or other lesions.
2. Indicate the regional distribution, such as shoulders, upper arms, trunk, buttocks, thighs, etc.
3. Indicate the percentage of skin involvement; less than 10 percent or greater than 10 percent.
4. Indicate the TNM Staging of Mycosis Fungoides, such as Ia, Ib, IIa, IIb, III, IVa, or IVb.
5. Indicate whether visceral organs are involved or not.
6. Indicate if there is lymph node involvement or not.

3. The Treatment Records for the entire claim period for which reimbursement is being requested. This documentation must clearly indicate the following:

1. The dosage regimen of PUVA; ex., Once a week or twice a week.
2. Any other regimen the patient may be receiving such as:

1. Topical chemotherapy;
2. Local electron beam or x-ray therapy;
3. Interferon alfa;
4. Retinoids.

4. Clinical Notes for the entire claim period for which reimbursement is being requested. The documentation must indicate that the patient's condition is improving or that stopping phototherapy would exacerbate the patient's condition.

1. Improvement of the patient's condition may be indicated by one or all of the following:

1. A decrease in the frequency of PUVA treatments;
2. A decrease in the number of skin lesions, ex., plaques;
3. A decrease in the amount of skin involved;
4. A decrease in pruritus.

2. Note: It is generally and medically acceptable to continue PUVA therapy to prolong the duration of remission in some patients. If this is the case, the records must clearly document this.
3. Note: A progress note should be documented at least every 30 days.

5. Laboratory and Diagnostic Reports pertinent to all the services billed must be available upon request. These may include but are not limited to:

1. Skin biopsy reports;
2. Lymph node biopsy reports;
3. Chest x-ray reports;
4. CT scan reports;
5. Blood work reports.

CPT codes and descriptions only are copyright 2004 American Medical Association (or other such date publication of CPT).