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Vitiligo Support GroupJanuary 13, 2015
Seemal R. Desai, MD, FAADClinical Assistant Professor
Dept of Dermatology
Innovative DermatologyPlano, TX
www.innovative-dermatology.com
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Phototherapy
• Phototherapy or Light Therapy is a service billed to insurance with one of these codes.– 96910 code for Narrowband UVB treatment– 96920/96921/96922 codes for Excimer laser treatment
• Medicare/Medicaid track and make payments based on the above codes• Payment for NB-UVB increased over the past 15 years, except 2013-2014• In 2013, payment was decreased by 9.26%, mainly due to allocation of
funds that are no longer part of the Practice Expense, by CMS (Centers for Medicare & Medicaid Services) for non-physician staff
• Due to the payment decrease, Phototherapy is under threat, and…therefore treatment for patients suffering from vitiligo
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Insurance Coverage for Phototherapy and Excimer in Texas
Phototherapy ExcimerBCBS
YESBCBS
NO
Cigna YES
Cigna NO
United Healthcare YES
United Healthcare YES
Aetna YES
Aetna YES
Medicare NO
Medicare NO
**Your dermatologist may need to write a Letter of Medical Necessity
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Topical Therapies
• Some drugs and topical creams still gets denied from insurance coverage, especially when topical steroids have not been tried.
• Topical Steroids used to cost less earlier– Clobetasol ointment 60gram costs $315.00 now, used to be
approximately $30 for same quantity– GoodRx (http://www.goodrx.com/) is a great source to check
pharmacy prices for medicines in your zip code• No price regulation of generic manufacturers, so prices could rise,
and many dermatologists now prescribe brand names as a result.
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What can you do?
• Write to our elected officials and express to them your concern about cuts to Medicare and the SGR(Sustainable Growth Rate)– Use your own example of vitiligo, but needs to be a
“global” appeal• Texas Rep Burgess in Denton helped spearhead reform