Insurance Forms

This information is a general reference and is intended to assist the physician or provider in obtaining reimbursement for health care services. This is for informational purposes only. Nothing herein shall be construed as a statement, promise or guarantee regarding levels of reimbursement, payment or charge. Furthermore, all codes provided herein are for information purposes only, and shall not be construed as a statement, promise or guarantee that these codes are accurate or reimbursement will be received. The ultimate responsibility for correct coding lies with the physician or provider.




Insurance Help:
Need help with insurance? Let Anodyne guide the way:

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Insurance Reimbursement Guide:
Most major insurance companies now authorize or reimburse the purchase of bright light therapy equipment if the following documents are properly submitted.

It is recommended for a person to submit to their insurance company:

1) Cover letter: Your own cover letter to the insurance company to include all pertinent member information: policy number, referring physician and personal description

Click to download the Word Document

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Cover Letter Template

2) Prescription: A prescription from your psychiatrist or general practitioner

3) Invoice: An invoice (or quotation) from Northern Light Technologies for the light therapy device
***If using Anodyne’s services, they will provide an invoice***

4) Insurance Form: The insurance form must be filled out by your psychiatrist or general practitioner

Click to download the Insurance Form in PDF format

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Insurance Form

5) Additional resources: Additional resources may include Abstracts from Professional Journals such as:

JAMA Psychiatry. 2016;73:56-63. Lam RW, Levitt AJ, Levitan RD, et al. Efficacy of bright light treatment, fluoxetine, and the combination in patients with nonseasonal major depressive disorder: a randomized clinical trial.

Am J Psychiatry. 2005 Apr;162(4):656-62.
The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence.

Cochrane Database Sys Rev. 2005;2:CD004050. Tuunainen A, Kripke DF, Endo T.
Light therapy for non-seasonal depression.


Additional Information:
HCPCS Codes:
E0203: Therapeutic lightbox 10,000 Lux
A4634: Replacement bulb for therapeutic lightbox, tabletop model