Coverage Policy Manual
Policy #: 2002009
Category: Medicine
Initiated: June 2002
Last Review: February 2019
  Phototherapy for Psoriasis

Description:
 Light therapy for psoriasis includes both targeted phototherapy and photochemotherapy with psoralen plus ultraviolet A (PUVA). Targeted phototherapy describes the use of ultraviolet light that can be focused on specific body areas or lesions. PUVA uses a psoralen derivative in conjunction with long wavelength ultraviolet A (UVA) light (sunlight or artificial) for photochemotherapy of skin conditions.
 
Background
Psoralens with ultraviolet A (UVA) uses a psoralen derivative in conjunction with long wavelength UVA light (sunlight or artificial) for photochemotherapy of skin conditions. Psoralens are tricyclic furocoumarins that occur in certain plants and can also be synthesized. They are available in oral and topical forms. Oral PUVA is generally given 1.5 hours before exposure to UVA radiation. Topical PUVA therapy refers to directly applying the psoralen to the skin with subsequent exposure to UVA light. Bath PUVA is used in some European countries for generalized psoriasis, but the agent used, trimethylpsoralen, is not approved by the U.S. Food and Drug Administration (FDA). Paint PUVA and soak PUVA are other forms of topical application of psoralen and are often used for psoriasis localized to the palms and soles. In paint PUVA, 8-methoxypsoralen (8-MOP) in an ointment or lotion form is put directly on the lesions. With soak PUVA, the affected areas of the body are placed in a basin of water containing psoralen. With topical PUVA, UVA exposure is generally administered within 30 minutes of psoralen application.
 
PUVA has most commonly been used to treat severe psoriasis, for which there is no generally accepted first-line treatment. Each treatment option (e.g., systemic therapies such as methotrexate, phototherapy, biologic therapies, etc.) has associated benefits and risks. Common minor toxicities associated with PUVA include erythema, pruritis, irregular pigmentation, and gastrointestinal tract symptoms; these generally can be managed by altering the dose of psoralen or UV light. Potential long-term effects include photoaging and skin cancer, particularly squamous cell carcinoma (SCC) and possibly malignant melanoma. PUVA is generally considered more effective than targeted phototherapy for the treatment of psoriasis. However, the requirement of systemic exposure and the higher risk of adverse reactions (including a higher carcinogenic risk) have generally limited PUVA therapy to patients with more severe cases.
 
Potential advantages of targeted phototherapy include the ability to use higher treatment doses and to limit exposure to surrounding tissue. Broadband ultraviolet B (BB-UVB) devices, which emit wavelengths from 290 to 320 nm, have been largely replaced by narrowband (NB)-UVB devices. NB-UVB devices eliminate wavelengths below 296 nm, which are considered erythemogenic and carcinogenic but not therapeutic. NB-UVB is more effective than BB-UVB and approaches PUVA in efficacy. Original NB-UVB devices consisted of a Phillips TL-01 fluorescent bulb with a maximum wavelength (lambda max) at 311 nm. Subsequently, xenon chloride (XeCl) lasers and lamps were developed as targeted NB-UVB treatment devices; they generate monochromatic or very narrow band radiation with a lambda max of 308 nm. Targeted phototherapy devices are directed at specific lesions or affected areas, thus limiting exposure to the surrounding normal tissues. They may therefore allow higher dosages compared to a light box, which could result in fewer treatments to produce clearing.
 
The original indication of the excimer laser was for patients with mild to moderate psoriasis, defined as involvement of less than 10% of the skin. Typically, these patients have not been considered candidates for light box therapy, since the risks of exposing the entire skin to the carcinogenic effects of UVB light may outweigh the benefits of treating a small number of lesions. Newer XeCl laser devices are faster and more powerful than the original models, which may allow treatment of patients with more extensive skin involvement, 10–20% of body surface area. The American Academy of Dermatology does not recommend phototherapy for patients with mild localized psoriasis whose disease can be controlled with topical medications (Menter, 2010). A variety of topical agents are available including steroids, coal tar, vitamin D analogues (e.g., calcipotriol and calcitriol), tazarotene, and anthralin.
 
Regulatory Status
In 2001, an XeCl excimer laser (XTRAC™ by PhotoMedex) received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for the treatment of mild to moderate psoriasis. The 510(k) clearance has subsequently been obtained for a number of targeted UVB lamps and lasers, including newer versions of the XTRAC system including the XTRAC Ultra™, the VTRAC™ lamp (PhotoMedex), the BClear™ lamp (Lumenis), and the European manufactured Excilite™ and Excilite µ™ XeCl lamps.
 
The oral psoralen products Oxsoralen-Ultra (methoxsalen soft gelatin capsules) and 8-MOP (methoxsalen hard gelatin capsules) have been approved by the FDA; both are made by Valeant Pharmaceuticals. Topical psoralen products have also received FDA approval e.g., Oxsoralen (Valeant Pharmaceuticals).
 
Coding
In 2002, CPT established separate codes (96920-96922) that describe ultraviolet light laser treatment for inflammatory disease (psoriasis) according to the surface area of skin treated (total area less than 250 sq cm, 250 sq cm–500 sq cm, over 500 sq cm).
 
The laser treatment codes are distinct from codes that describe the dermatological use of ultraviolet light, also known as actinotherapy (96900), and photochemotherapy (96910-96913).
  

Policy/
Coverage:
Effective July 2013
Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria
 
PUVA for the treatment of severe, disabling psoriasis, which is not responsive to other forms of conservative therapy (e.g., topical corticosteroids, coal/tar preparations, and ultraviolet light), meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.
 
Targeted phototherapy (e.g., lamp or laser therapy) meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes for the treatment of:
    • moderate to severe localized psoriasis (i.e., comprising less than 20% body area) which is not responsive to other forms of conservative therapy (e.g., sunlight, topical steroids, coal tar preparations, calcipotriene (Dovonex®), vitamin A (Tazarotene®), Anthralin®,  fluocinonide (Lidex®), and other various topical preparations). Failure of an adequate trial of conventional treatment must be documented.
    • mild to moderate localized psoriasis that is unresponsive to conservative treatment.
*Note: A course of treatment will consist of no more than 10 sessions. A session includes all areas treated on a date of service. An additional course of treatment is allowed when there is documentation of a positive response to the initial course and gradual worsening over time.
 
Does Not Meet Primary Coverage Criteria Or Is Investigational For Contracts Without Primary Coverage Criteria
 
Targeted phototherapy (e.g., lamp or laser therapy) for the first-line treatment of psoriasis does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.
 
For members with contracts without primary coverage criteria, targeted phototherapy (e.g., lamp or laser therapy) for the first-line treatment of psoriasis is considered investigational. Investigational services are specific contract exclusions in most member benefit certificates of coverage.
 
Targeted phototherapy for the treatment of generalized psoriasis or psoriatic arthritis does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.
 
For members with contracts without primary coverage criteria, targeted phototherapy for the treatment of generalized psoriasis or psoriatic arthritis is considered investigational. Investigational services are specific contract exclusions in most member benefit certificates of coverage.
 
Effective prior to July 2013
Treatment with Xenon Chloride Excimer Laser therapy meets primary coverage criteria for effectiveness and is covered when:
    • Treatment is for localized, symptomatic psoriasis when conventional treatment has failed.  Conventional treatment might include sunlight, topical steroids, coal tar preparations, calcipotriene (Dovonex®), vitamin A (Tazarotene®), Anthralin®,  fluocinonide (Lidex®), and other various topical preparations.  Failure of an adequate trial of conventional treatment must be documented.
    • Total treatment area is equal to or less than 20% of body surface ("5 palms worth");
    • No more than 10 sessions per course of treatment; a session includes all areas treated on a date of service;
    • An additional course of treatment is covered when there is documentation of a positive response to the initial course and gradual worsening over time.

Rationale:
Technical literature indicates that handheld narrowband UVB (NB-UVB) delivery devices can be considered similar to conventional phototherapeutic lights since they produce wavelengths of light that are within the therapeutic range. Clinical guidelines from the British Association of Dermatologists state that panel irradiators and point sources are acceptable alternatives to whole-body cabinets or upright panels, with each light source having its advantages and disadvantages.  Guidelines on the treatment of psoriasis from the American Academy of Dermatology also indicate that targeted phototherapy is an appropriate alternative to PUVA or UVB (with or without topical or oral retinoids) for the treatment of moderate to severe localized disease. Their guidelines do not recommend phototherapy for limited (mild) psoriasis, erythrodermic/generalized psoriasis or psoriatic arthritis.
 
Clinical Efficacy
Two blinded and controlled studies compared targeted UVB with standard phototherapy of psoriasis; both used equivalent starting doses and patches matched on either side of the body.  One study compared a NB-UVB lamp with cream PUVA in 10 subjects with palmoplantar psoriasis.  The UVB lamp and PUVA-treated sides showed similar gradual clearing over the course of 20 treatments, reaching 64% clearance at the end of the 5-week treatment period. In the other blinded study the excimer laser was compared to full body NB-UVB in 16 patients with psorias vulgaris.  At the end of 20 treatments the psoriasis area and severity scores (PASI) were equally reduced on the two sides, from a baseline of 11.8 to 6.3 for laser and from 11.8 to 6.9 for non-targeted NB-UVB. A patch comparison in 15 patients with stable plaque also found no difference in efficacy between the 308-nm laser, the 308-nm excimer lamp, and standard TL-01 lamps.
 
A multicenter open trial of 124 patients with mild to moderate psoriasis reported effective clearance of lesions among the 80 patients who completed XeCl laser treatment.  Comparison of these results to historical controls found laser therapy to be more effective than placebo and comparable or more effective to other standard treatments for psoriasis.   Controlled studies comparing targeted phototherapy with topical treatment for patients with mild disease are lacking.
 
Treatment-resistant plaques
Clinical studies suggest that targeted phototherapy can be effective for treatment-resistant lesions. One controlled patch comparison reported effective clearing (PASI pre 6.2, PASI post 1.0) of treatment- resistant psoriatic lesions; 6 of the patients had previously received topical treatment, 5 had received conventional phototherapy, and 3 had received combined treatments including phototherapy.  The same group reported that 12 of 13 subjects with “extensive and stubborn” scalp psoriasis (i.e., unresponsive to class I topical steroids used in conjunction with tar and/or zinc pyrithione shampoos for at lease 1 month) showed clearing following treatment with the 308-nm laser.  In a recent open trial from Europe, 44 of 54 patients with palmoplantar psoriasis resistant to combined phototherapy and systemic treatments were cleared of lesions with only 1 NB-UVB lamp treatment per week for 8 weeks.
 
Dosing
Results suggest that targeted dosing may be more effective than dosing based on the minimal erythematic dose (MED) of unaffected skin. One study evaluated dosing in 163 patients with the XeCl laser.  Initially, 120 patients with mild to moderate localized plaque were treated beginning at 3 times the MED of unaffected skin, increasing by 1 MED unless an erythematous reaction occurred on the psoriatic skin. Of the 102 patients who completed 13 treatment sessions, 87 had > 90% clearance of lesions. Based on the findings in the first treatment group, a second group of 43 patients had treatment initiated at a MED level in accordance with the epidermal thickness of the psoriatic lesion, as determined by ultrasound, to maximize therapeutic effect while minimizing adverse side effects; 34 of 40 patients (83.7%) achieved clearance of lesions in only 7.07 ± 2.15 sessions, resulting in a lower cumulative dose of UVB. A patch comparison (described above) found no difference in efficacy between targeted laser, targeted lamp, or standard TL-01 lamps when all were administered at the standard NB-UVB dose.  However, when the investigators used an accelerated dosing scheme to compare the two targeted devices (16 patients), clearance was achieved with fewer treatments and half the cumulative dose of the first regime. Thus, targeted phototherapy may allow higher (and more therapeutic) doses of light to be delivered to the lesion in comparison with dosing based on the erythematic dose of unaffected skin. Controlled studies based on the MED of the patch/lesion are needed to determine the most effective treatment and maintenance schedules.
 
There is concern for the possibility of cancer induction with long-term UVB treatment. PUVA has been associated with increased cancer risk; there is currently no evidence that supports increased risk following extended UVB treatment.  Given the higher MED of plaques and reduced exposure of unaffected skin, targeted NB-UVB may have an improved benefit/risk ratio over non-targeted phototherapy for localized psoriasis.
 
There is currently no evidence to recommend any one targeted or non-targeted NB-UVB device over another. Devices with smaller focal areas may result in more frequent blistering due to “tiling,” the practice of overlapping adjoining treatment zones.
 
The literature supports the use of targeted phototherapy for the treatment of moderate to severe psoriasis comprising less than 20% body area for which NB-UVB or PUVA are indicated, and for the treatment of mild to moderate psoriasis that is unresponsive to conservative treatment.
 
Based on this medical literature, evidence is lacking for the use of targeted phototherapy for the first-line treatment of mild psoriasis or for the treatment of generalized psoriasis or psoriatic arthritis.
 
2007 Update
Initial studies did not include patients with psoriasis of the scalp.  Recent medical literature has reported on the efficacy of the excimer laser in patients who had failed intensive topical therapy.
 
2009 Update
A search of the MEDLINE database was performed for the time period of August 2007 through March 2009.  There were no randomized trials identified that would change the coverage statement.
 
2012 Update
A literature search conducted through January 2012 did not reveal any new information that would prompt a change in the coverage statement.
 
2013 Update
A literature search conducted through February 2013 found no new information that would prompt a change in the coverage statement. The following is a summary of the key identified literature.
 
Targeted Phototherapy
In 2012, Mudigonda and colleagues published a systematic review of controlled studies comparing the 308-nm UVB excimer laser to non-targeted phototherapy for patients with localized psoriasis (Mudigonda, 2012). The authors identified 3 prospective non-randomized studies comparing the 308-nm excimer laser to narrow-band UVB (NB-UVB); no studies comparing the excimer laser with broad band UVB (BB-UVB) or psoralens with ultraviolet A (PUVA) were identified. Among the 3 studies was one by Goldinger and colleagues that compared the excimer laser to full body NB-UVB in 16 patients (Goldfinger, 2006). At the end of 20 treatments, the psoriasis area and severity index (PASI) scores were equally reduced on the 2 sides, from a baseline of 11.8 to 6.3 for laser and from 11.8 to 6.9 for non-targeted NB-UVB. Another study, by Kollner and colleagues, included 15 patients with stable plaque psoriasis (Kollner, 2005). The study compared the 308-nm laser, the 308-nm excimer lamp, and standard TL-01 lamps. One psoriatic lesion per patient was treated with each therapy (i.e., each patient received all 3 treatments). The investigators found no significant difference in the efficacy of the 3 treatments after 10 weeks. The mean number of treatments to achieve clearance of lesions was 24.
 
In 2012, Wollina and colleagues in Germany treated two target lesions of similar size in 21 adult patients with moderate plaque-type psoriasis (Wollina, 2012). One lesion was treated with a new 307-nm excimer laser (which may not be available in the United States) and the other with a topical dithranol ointment. At baseline, the mean psoriasis score index (PSI) was 7.5 in the laser group and 6.9 in the dithranol group. The mean improvement in the PSI score after 3 treatments and a mean of 9 days of follow-up was 3.0 points in each group. The difference in improvement between groups was not statistically significant; this suggests similar efficacy although that conclusion is not definitive due to the small sample size. Treatment tolerance was higher with targeted phototherapy. All dithranol-treated lesions became irritated and had staining. Eleven of 21 targeted phototherapy-treated lesions (52%) had mild-to-moderate erythema and 2 (14%) had temporary blistering.
 
Psoralens with Ultraviolet A
In 2012, an industry-sponsored systematic review by Archier and colleagues was published on psoralens with ultraviolet A and/or narrow-band UVB for treating psoriasis (Archier, 2012). Three randomized controlled trials (RCTs) were identified that directly compared PUVA to NB-UVB in patients with chronic plaque psoriasis. A pooled analysis of these studies found a significantly higher psoriasis clearance with PUVA compared to NB-UVB (odds ratio [OR]: 2.79; 95% confidence interval [CI]: 1.40 to 5.55). In addition, significantly more patients remained cleared at 6 months with PUVA compared to NB-UVB (OR: 2.73: 95% CI: 1.18 to 6.27).
 
2014 Update
A literature search conducted through June 2014 did not reveal any new information that would prompt a change in the coverage statement. The key identified literature is summarized below.
 
There are several systematic reviews of the literature on targeted phototherapy. Reviews differed in the type of study they included and in the comparison interventions.
 
In a 2013 systematic review by Almutawa et al, psoralen plus ultraviolet A (PUVA) was the comparison intervention and only evidence from randomized controlled trials (RCTs) was considered (Almutawa, 2013a). The authors identified 3 RCTs comparing the efficacy of targeted ultraviolet B (UVB) phototherapy with PUVA for treatment of plaque psoriasis. Two of the 3 studies used an excimer laser (308-nm) as the source of targeted phototherapy, and the third study used localized narrowband (NB)-UVB light. There was heterogeneity among studies, and thus a random effects meta-analysis model was used. Using the random effects model, there was not a statistically significant difference between the 2 techniques in the proportion of patients with at least a 75% reduction in psoriasis. The pooled odds ratio (OR) was 3.48 (95% confidence interval [CI], 0.56 to 22.84). (The wide confidence interval indicated a lack of precision in the efficacy estimate).
 
A 2013 systematic review by Almutawa et al identified 8 RCTs that evaluated oral PUVA and reporting PASI-75 as an outcome measure (Almutawa, 2013b). The mean percentage of patients achieving PASI-75 was 73% (95% CI, 56% to 88%). The mean clearance rate in 10 trials of PUVA monotherapy was 79% (95% CI, 68% to 88%). In 4 trials with bath PUVA monotherapy, the mean proportion of patients achieving PASI-75 was 47% (95% CI, 30% to 65%). The authors did not report outcomes in the control groups and thus conclusions cannot be drawn from this analysis on the relative efficacy of PUVA and other psoriasis treatments. A Cochrane review was published in 2013 on light therapy for psoriasis (Chen, 2013). However, that review is less useful for the analysis at hand because the authors combined results of studies using PUVA and BB-UVB, rather than reporting outcomes separately for these 2 treatment modalities.
 
2015 Update
A literature search conducted through January 2015 did not reveal any new information that would prompt a change in the coverage statement. The key identified literature is summarized below.
 
Assessment of efficacy for therapeutic interventions involves a determination of whether the intervention improves health outcomes. The optimal study design for a therapeutic intervention is a randomized controlled trial (RCT) that includes clinically relevant measures of health outcomes. Intermediate outcome measures, also known as surrogate outcome measures, may also be adequate if there is an established link between the intermediate outcome and true health outcomes. Nonrandomized comparative studies and uncontrolled studies can sometimes provide useful information on health outcomes, but are prone to biases such as selection bias (eg, noncomparability of treatment groups) and observation bias (eg, the placebo effect).
 
A small 2014 sham-controlled RCT by Levin et al evaluated the Levia targeted NB-UVB device (Levin, 2014). Although the device can be used at home, in the trial, treatments were provided by experienced phototherapists in a clinical setting. The study included patients with bilateral plaque-type psoriasis who had symmetric target lesions 2 to 4 cm in diameter. The minimum target lesion score (TLS) was 6, indicating at least moderate severity. (TLS is a 12-point scale that incorporates erythema, lesion thickness, and scaling.) Patients received targeted phototherapy on a randomly selected side of the body and sham (visible light treatment) on the other side. Treatments were given 3 times weekly for 12 weeks. Seventeen (81%) of 21 randomized patients completed the study. The primary end point, percentage of lesions that were clear or almost clear (TLS 3) at week 12 did not differ significantly between groups. The end point was attained on 10 treated lesions and 7 sham lesions (p=0.118). Two of 3 prespecified secondary end points significantly favored active treatment. The percentage improvement in TLS was 43% on the treated side and 29% on the sham side (p=0.043). In addition, 12 lesions in the treated group and 7 in the placebo group had at least 50% improvement as measured by TLS (p=0.020). However, percentage improvement in pruritus visual analog score, 62% on the treated side and 27% on the sham side, did not differ significantly between groups. The study had a relatively high dropout rate but since patients served as their own controls, this is not likely to be a major source of bias.
 
In 2014, El-Mofty et al in Egypt published an RCT comparing PUVA and BB-UVA in 61 patients with psoriasis affecting at least 30% body surface area (El-Mofty, 2014).  Patients in the BB-UVA group were further randomized to 1 of 2 fixed doses: 10 or 15 J/cm2 per session. A maximum of 48 treatment sessions were provided. Clinical outcomes were significantly better in the PUVA group than the BB-UVA groups. For example, complete clearance was obtained by 23 (77%) of 30 patients in the PUVA group, 5 (31%) of 16 patients in the 10 J/cm2 UVA group, and 5 (33%) of 15 patients in the 15 J/cm2 UVA group (p=0.020).
 
2016 Update
A literature search conducted through January 2016 did not reveal any new information that would prompt a change in the coverage statement. The key identified literature is summarized below.
 
A 2013 systematic review by Almutawa and colleagues considered only RCTs; psoralen plus ultraviolet A (PUVA) was the comparison intervention (Almutawa, 2013). The authors identified 3 RCTs comparing the efficacy of targeted ultraviolet B (UVB) phototherapy with PUVA for treatment of plaque psoriasis. Two of the 3 studies used an excimer laser (308 nm) as the source of targeted phototherapy, and the third study used localized narrowband (NB)-UVB light. There was heterogeneity among studies, and thus a random effects meta-analysis model was used. Using the random effects model, there was not a statistically significant difference between the 2 techniques in the proportion of patients with at least a 75% reduction in psoriasis. The pooled odds ratio (OR) was 3.48 (95% confidence interval [CI], 0.56 to 22.84). (The wide confidence interval indicated a lack of precision in the efficacy estimate.)
 
2017 Update
A literature search conducted through January 2017 did not reveal any new information that would prompt a change in the coverage statement.
 
2018 Update
Annual policy review completed with a literature search using the MEDLINE database through February 2018. No new literature was identified that would prompt a change in the coverage statement. The key identified literature is summarized below.
 
National Psoriasis Foundation
In 2017, the National Psoriasis Foundation published a consensus guidance based on a task force review of the literature on the treatment for psoriasis involving skinfolds (inverse or intertriginous) psoriasis (Khosravi, 2017). The treatment guidance for intertriginous or genital psoriasis stated: “…there is anecdotal evidence demonstrating the strong clinical efficacy of biologic treatment; with limited knowledge on the effects of biologics on intertriginous or genital psoriasis.”
 
In 2017, the National Psoriasis Foundation also published recommendations based on a review of the literature on the treatment for psoriasis in solid organ transplant patients (Prussick, 2017). Because organ transplant patients are excluded from randomized controlled trials, there are limited data.
 
2019 Update
Annual policy review completed with a literature search using the MEDLINE database through January 2019. No new literature was identified that would prompt a change in the coverage statement.

CPT/HCPCS:
96900Actinotherapy (ultraviolet light)
96912Photochemotherapy; psoralens and ultraviolet A (PUVA)
96920Laser treatment for inflammatory skin disease (psoriasis); total area less than 250 sq cm
96921Laser treatment for inflammatory skin disease (psoriasis); 250 sq cm to 500 sq cm
96922Laser treatment for inflammatory skin disease (psoriasis); over 500 sq cm

References: Almutawa F, Alnomair N, Wang Y et al.(2013) Systematic review of UV-based therapy for psoriasis. . Am J Clin Dermatol 2013b; 14(2):87-109.

Almutawa F, Thalib L, Heckman D et al.(2013) Efficacy of localized phototherapy and photodynamic therapy for psoriasis: a systematic review and meta-analysis. Photodermatol Photoimmunol Photomed 2013a.

Almutawa F, Thalib L, Hekman D, et al.(2015) Efficacy of localized phototherapy and photodynamic therapy for psoriasis: a systematic review and meta-analysis. Photodermatol Photoimmunol Photomed. Jan 2015;31(1):5-14. PMID 24283358

Archier E, Devaux S, Castela E et al.(2012) Efficacy of psoralen UV-A therapy vs. narrowband UV-B therapy in chronic plaque psoriasis: a systematic literature review. J Eur Acad Dermatol Venereol 2012; 26 Suppl 3:11-21.

Asawanonda P, Anderson RR, Chang Y, et al.(2000) 308-nm excimer laser for the treatment of psoriasis: a dose-response study. Arch Derm 2000; 136:619-24.

Barbagallo J, Spann CT, Tutrone WD, et al.(2001) Narrow band UVB phototherapy for the treatment of psoriasis: a review and update. Cutis 2001; 68:345-7.

Callen JP, Krueger GG, et al.(2003) ADD consensus statement on psoriasis therapies. J Am Acad Dermatol, 2004; 49:897-9.

Chen X, Yang M, Cheng Y et al.(2013) . Narrow-band ultraviolet B phototherapy versus broad-band ultraviolet B or psoralen-ultraviolet A photochemotherapy for psoriasis. Cochrane Database Syst Rev 2013; 10:CD009481.

Feldman SR, Mellen BG, Housman TS, et al.(2002) Efficacy of the 308-nm excimer laser for treatment of psoriasis: results of multicenter study. J Am Acad Derm 2002; 46: 900-6.

Gerber W, Arheilger B, et al.(2003) Ultraviolet B 308-nm excimer laser treatment of psoriasis: a new phototherapeutic approach. Br J Dermatol, 2003; 149:1250-8.

Gerber W, Arheilger B, Ha TA, et al.(2003) Ultraviolet B 308-nm excimer laser treatment of psoriasis: a new phototherapeutic approach. Br J Dermatol 2003; 149(6):1250-8.

Goldinger SM, Dummer R, et al.(2006) Excimer laser versus narrow-band UVB (311nm) in the treatment of psoriasis vulgaris. Dermatology, 2006; 213:134.

Goldinger SM, Dummer R, Schmid P et al.(2006) Excimer laser versus narrow-band UVB (311 nm) in the treatment of psoriasis vulgaris. Dermatology 2006; 213(2):134.

Hamzavi I, Lui H.(2005) Using light in dermatology: an update on lasers, ultraviolet phototherapy, and photodynamic therapy. Dermatol Clin, 2005; 23:199-207.

Ibbotson SH, Bilsland D, et al;(2004) An update and guidance on narrowband ultraviolet B phototherapy: A British Photodermatology Group Workshop Report. British Assoc of Dermatologists. Br J Dermatol, 2004; 151:283-97.

Khosravi H, Siegel MP, Van Voorhees AS, et al.(2017) Treatment of inverse/intertriginous psoriasis: updated guidelines from the Medical Board of the National Psoriasis Foundation. J Drugs Dermatol. Aug 01 2017;16(8):760-766. PMID 28809991.

Kollner K, Wimmershoff MB, et al.(2005) Comparison of the 308-nm excimer laser abd a 308-nm excimer lamp with 311-nm narrowband ultraviolet B in the treatment of psoriasis. Br J Dermatol, 2005; 152:750-4.

Kollner K, Wimmershoff MB, Hintz C et al.(2005) Comparison of the 308-nm excimer laser and a 308-nm excimer lamp with 311-nm narrowband ultraviolet B in the treatment of psoriasis. Br J Dermatol 2005; 152(4):750-4.

Lee E, Koo J, Berger T.(2005) UVB phototherapy and skin cancer risk: a review of the literature. Int J Dermatol, 2005; 44:355-60.

Mavilla L, Mori M, Rossi R et al.(2008) 308 nm monochromatic excimer light in dermatology: personal experience and review of the literature. G Ital Dermataol Venereol. 2008 Oct;143(5):329-337.

Morison WL, Atkinson DF, Werthman L.(2006) Effective treatment of scalp psoriasis using the excimer (308 nm) laser. Photodermatol Photoimmunol Photomed, 2006; 22:181-3.

Mudigonda T, Dabade TS, West CE et al.(2012) Therapeutic modalities for localized psoriasis: 308-nm UVB excimer laser versus nontargeted phototherapy. Cutis 2012; 90(3):149-54.

Neumann NJ, Mahnke N, et al.(2006) Treatment of palmoplantar psoriasis with monochromatic excimer light (308-nm) versus cream PUVA. Acta Derm Venereol, 2006; 86:22-4.

Nistico SP, Saraceno R, et al.(2006) A 308-nm monochromatic excimer light in the treatment of palmoplantar psoriasis. J Eur Acad Dermatol Venereol, 2006; 20:523-6.

Prussick R, Wu JJ, Armstrong AW, et al.(2017) Psoriasis in solid organ transplant patients: best practice recommendations from The Medical Board of the National Psoriasis Foundation. J Dermatolog Treat. Oct 24 2017:1-5. PMID 28884635

Spann CT, Barbagallo J, Weinberg JM.(2001) A review of the 308 nm excimer laser in the treatment of psoriasis. Cutis 2001; 68:351-2.

Taneja A, Trehan M, Taylor C.(2003) 308-nm Excimer Laser for the Treatment of Psoriasis - Induration-Based Dosimetry. Arch Dermatol 2003; 139:759-764.

Taylor CR, Racette Al.(2004) A 308-nm excimer laser for the treatment of scalp psoriasis. Lasers Surg Med 2004; 34(2):136-40.

Taylor CR, Racette AL.(2004) A 308-nm excimer laser for the treatment of scapl psoriasis. Lasers Surg Med, 2004; 34:136-40.

Trehan M, Taylor CR.(2002) High-dose 308-nm excimer laser for the treatment of psoriasis. J Am Acad Derm 2002; 46:732-7.

Wollina U, Koch A, Scheibe A et al.(2012) Targeted 307 nm UVB-phototherapy in psoriasis. A pilot study comparing a 307 nm excimer light with topical dithranol. Skin Res Technol 2012; 18(2):212-8.


Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants or to the Tyson Group Health Plan participants.
CPT Codes Copyright © 2019 American Medical Association.