BlueCross BlueShield of Tennessee Medical Policy Manual

Light Emitting Diode (LED) Therapy

DESCRIPTION

Light emitting diode (LED) therapy utilizes a device (e.g., Anodyne Therapy System, Pain-X-2000, BioScan, Light Force Therapy) that delivers light to targeted tissue. This is done through multiple superluminous infrared diodes located on a flexible pad that is in contact with the skin. LED therapy may also be referred to as monochromatic infrared energy (MIRE), infrared energy therapy, infrared light therapy or infrared heating pad system.

LED therapy devices use one (monochromatic) or two wavelengths of infrared (invisible) light with or without red (visible) light. The light is measured in nanometers (880nm), with a higher nanometer number denoting a greater depth of tissue penetration. Treatment is administered several times a week over a period of weeks to months. LED therapy can be provided in an office or home setting.

LED therapy is being proposed for the treatment of diabetic peripheral neuropathy, lymphedema, non-healing wounds and muscle pain. Treatment is based on the premise that LED therapy may cause an increase in nitric oxide concentrations that may lead to increased blood flow and promote vasodilatation.

POLICY

See also:  Laser Therapy for Miscellaneous Applications

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

Scientific evidence in peer review literature is lacking regarding the use, safety, improvement or effectiveness on health outcomes for light emitting diode therapy.

SOURCES

Ammar, T. (2012) Monochromatic infrared photo energy in diabetic peripheral neuropathy. International Scholarly Research Network Rehabilitation. Volume 2012, Article ID 484307. (Level 2 evidence)

BlueCross BlueShield Association. Medical Policy Reference Manual (Archived 12:2015) Skin contact monochromatic infrared energy as a technique to treat cutaneous ulcers, diabetic neuropathy, and miscellaneous musculoskeletal conditions. (1.01.22) Retrieved from BlueWeb December 22, 2015. (16 articles and/or guidelines reviewed)

Center for Medicare & Medicaid Services. CMS.gov. (2015, October) Local Coverage Determination (LCD): Outpatient physical and occupational therapy services (L33631) Retrieved December 22, 2015 from: https://www.cms.gov.

Lavery, L., Williams, J., Murdoch, D., and Lavery, D. (2008, February). Does anodyne light therapy improve peripheral neuropathy in diabetes? a double-blind, sham-controlled, randomized trial to evaluate monochromatic infrared photoenergy. Diabetes Care. 31:316-321. (Level 2 evidence)

U. S. Food and Drug Administration. (2006, December). Center for Devices and Radiological Health. 510(k) Premarket notification database K062635. Retrieved December 22, 2015 from:  http://www.accessdata.fda.gov.

U. S. Food and Drug Administration. (2011, January). Center for Devices and Radiological Health. 510(k) Premarket notification database K101894. Retrieved December 22, 2015 from:  http://www.accessdata.fda.gov.

ORIGINAL EFFECTIVE DATE:  12/1/2003  

MOST RECENT REVIEW DATE:  2/25/2016

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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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