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Medical Review - Experimental/Investigational

Phototherapy Light for the Treatment of Seasonal Affective and Other Depressive Disorders

DESCRIPTION
Seasonal affective disorder (SAD) is defined as a history of major depressive episodes that recur regularly at a particular time of year, typically winter. SAD is associated with decreases in ambient light exposure during the winter season; therefore, phototherapy, delivered by a light box or light visor, has been used as a treatment. Most commonly, white light is used at an intensity equaling that of a bright summer day – 2500 lux or higher. Currently, no phototherapy device has final market approval from the U.S. Food and Drug Administration (FDA) for the treatment of SAD or other depressive disorders.

POLICY
Phototherapy for the treatment of seasonal affective or other depressive disorders is investigational based on TEC assessment indicating lack of adequate studies supporting benefit.

HCPCS Codes
A4634
E0203

Determined by the Medical Director on October 26, 2004.

(Web updated 2/2005)

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