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Independence Blue CrossCommercial · Administrative · Medical Policy · Psychiatry, Internal Medicine, Family MedicineLow impact

05.00.69c, Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)

Effective date
Not stated in the notice
Identified
Jun 19, 2026

Summary

Independence Blue Cross reissued policy 05.00.69c on 04/01/2026 to communicate its continuing position on home-use light boxes for SAD treatment. No substantive coverage criteria or billing code changes were made—this is a routine policy maintenance reissuance. The policy remains unchanged: light boxes emitting 10,000 lux are covered when prescribed by a healthcare professional for members meeting specific DSM-5-TR seasonal pattern criteria.

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What to do

Action · 4 steps
01No immediate action required.
02This reissuance communicates no changes to coverage, billing codes, or documentation requirements.
03Billing team should verify current system reflects the existing coverage criteria: (1) diagnosis of recurrent major depressive episode or bipolar I/II disorder, depressed; (2) 10,000 lux light box with healthcare provider prescription; (3) DSM-5-TR seasonal pattern specifier documentation; (4) timely written orders on file; (5) proof of delivery documentation.
04If any claims were recently denied under this policy, review using the reconfirmed criteria above.

Codes mentioned

E0203A4634F31.30F31.31F31.32F31.4F31.5F31.75F31.76F31.81

Original notice

05.00.69c, Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
05.00.69c, Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)LowNo effective date · Medical PolicyMA05.022a, Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)LowNo effective date · Medical PolicyMA05.022a, Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)LowEffective Jan 1, 2023 · Medical PolicyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesPsychiatryInternal MedicineFamily MedicineCode E0203Code A4634Code F31.30Code F31.31Code F31.32Code F31.4Code F31.5Code F31.75Code F31.76Code F31.81

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