Red Light Therapy (RLT) has become a popular, non-invasive method for managing various physical conditions. As a treatment that uses specific wavelengths of light to stimulate cellular processes, the question of whether it is covered under Medicare is financially significant. Determining coverage requires navigating the complex rules of the Centers for Medicare & Medicaid Services (CMS), which governs what services are paid for under the federal program.
Defining Red Light Therapy and Its Common Uses
Red Light Therapy (RLT), also known as photobiomodulation (PBM) or low-level laser therapy (LLLT), uses light-emitting diodes (LEDs) or low-power lasers to apply red and near-infrared light to the body’s surface. This light, typically in the 600–1000 nanometer range, is absorbed by the cell’s mitochondria. The absorption is thought to stimulate energy production, which may accelerate tissue repair and reduce inflammation.
RLT is frequently sought for a variety of common conditions. Applications include pain management for chronic joint issues like osteoarthritis and musculoskeletal injuries. It is also used in dermatology for cosmetic purposes, such as reducing wrinkles, and treating inflammatory skin conditions like acne and psoriasis. The primary appeal lies in its non-thermal, non-invasive nature for promoting healing and relieving discomfort.
Standard Medicare Coverage Policy (Part A and B)
Original Medicare (Part A and Part B) operates under strict guidelines. For any service or item to be covered, it must be determined to be “reasonable and necessary” for the diagnosis or treatment of an illness or injury. Red Light Therapy (RLT) generally fails to meet this threshold for routine coverage.
The Centers for Medicare & Medicaid Services (CMS) currently considers RLT for most indications to be investigational, experimental, or not medically necessary. This classification means Medicare Part B, which covers most outpatient services, will not reimburse for the treatment. A significant barrier to coverage is the lack of specific, recognized Current Procedural Terminology (CPT) codes for RLT.
Providers often must bill using general codes like CPT 97039 (Unlisted Modality) or specific low-level laser therapy codes, such as S8948, which Medicare does not officially recognize. When these codes are used, Medicare Administrative Contractors (MACs) often deny the claim. MACs sometimes require the use of a modifier like GY, which signals that the service is statutorily excluded or non-covered. Many MACs have determined RLT to be non-covered, reinforcing the national trend of denial.
Potential Avenues for Coverage: Durable Medical Equipment and Specific Conditions
Coverage for an RLT device may be possible only if it qualifies as Durable Medical Equipment (DME) under Medicare Part B. To be considered DME, the device must withstand repeated use, be primarily for a medical purpose, be appropriate for use in the home, and be medically necessary as prescribed by a physician. RLT devices often meet the first three criteria, but they fail the strict “medically necessary” requirement for most common applications like pain or cosmetic skin issues.
A narrow exception exists if the RLT device is specifically indicated for a condition with sufficient clinical evidence, such as certain complex wound care scenarios. Even then, the modality often faces exclusion unless it meets non-standard criteria set by the local Medicare Administrative Contractor. Medicare does cover specific types of light therapy, such as ultraviolet (UV) phototherapy for severe psoriasis, but this is a separate modality from RLT.
If coverage is denied, providers are required to issue an Advance Beneficiary Notice of Noncoverage (ABN) to the patient. This notice informs the beneficiary that Medicare is likely to deny the claim because the service is not considered reasonable and necessary, transferring financial responsibility to the patient. In rare instances, coverage may be provided only if the device or therapy is part of a CMS-approved Investigational Device Exemption (IDE) study, limited to participants in specific clinical trials.
How Medicare Advantage (Part C) Differs
Medicare Advantage plans (Part C) are offered by private insurance companies that contract with Medicare. These plans must cover all the same services as Original Medicare. Since Original Medicare generally excludes RLT, Part C plans are not obligated to cover it either.
A key difference is that Medicare Advantage plans have the discretion to offer supplemental health benefits that Original Medicare does not. This flexibility sometimes includes coverage for alternative or integrative therapies, especially if they are part of a physician-prescribed pain management or rehabilitation program. A Part C plan may choose to cover RLT if it is deemed cost-effective for managing a chronic condition, such as joint pain.
This supplemental coverage is not universal, meaning RLT coverage is entirely plan-specific and geographically dependent. Beneficiaries must contact their individual Medicare Advantage plan provider to determine if their policy includes coverage for RLT. Without explicit coverage, the beneficiary remains responsible for the full out-of-pocket cost of the treatment or device.