Is Red Light Therapy Covered by Insurance? What to Expect

Struggling with the high cost of red light therapy? Many people hesitate because insurance coverage feels like a guessing game, leaving them unsure if treatments will break the bank. 

This uncertainty can stop you from experiencing the benefits you need. In this guide, we’ll clarify what insurance covers and what to expect, so you can make informed decisions without the stress.

• Coverage Is Rare: Most insurance plans don’t cover red light therapy.
  
  

• Medical Necessity Matters: A doctor’s prescription and documentation increase your chances of reimbursement.
  
  

• Evidence Drives Decisions: Insurers rely on clinical studies, guidelines, and FDA approval to determine coverage.
  
  

• Expect Variability: Coverage rules differ by provider, condition, and device type.
  
  

• Explore Affordable Options: Home devices, LED masks, gyms, and sunlight offer cost-effective alternatives.

Red light therapy (RLT) is generally not covered by most health insurance plans. The Cleveland Clinic notes that coverage is rare, so it’s wise to call your insurance company before seeking treatment. 

Some major insurers, like Aetna and Cigna, classify low-level light therapy as experimental for many conditions, including chronic pain, acne, and musculoskeletal issues, due to insufficient evidence.

The Centers for Medicare & Medicaid Services (CMS) specifically state that infrared and near-infrared treatments, including monochromatic infrared energy, are not covered for conditions such as diabetic or non-diabetic neuropathy, wounds, or ulcers. 

While certain dermatological uses, such as radiation dermatitis, may receive approval, most other indications, including arthritis, psoriasis, or back pain, lack broad insurance support. 

Patients hoping for coverage often need FDA-approved devices, documentation of a specific diagnosis, and a letter of medical necessity from their provider. 

Because policies vary widely, contacting your insurer directly is the most reliable way to understand if your treatment might be covered.

Insurance companies determine coverage by evaluating whether a treatment is “medically necessary,” a standard shaped by evidence-based guidelines like Milliman, Interqual, or CMS protocols. 

Medical necessity means the service must be safe, effective, clinically appropriate, and not primarily for convenience. 

Insurers also weigh clinical guidelines and peer-reviewed studies to confirm a treatment’s effectiveness and appropriateness. 

Experimental or alternative therapies are rarely covered unless supported by scientific evidence and prescribed by a licensed medical professional. 

Cost-effectiveness further influences decisions; research from the NATIONAL BUREAU OF ECONOMIC RESEARCH highlights that insurers balance societal and individual value when determining coverage and cost sharing. 

Even when guidelines are met, claims can be denied due to administrative errors, coverage gaps, or socioeconomic factors. 

A JAMA Network study found preventive care claims were denied in 1.34% of cases, with higher denial rates among lower-income, less-educated, and minority patients. Understanding these criteria helps patients navigate insurance decisions more effectively.

Red light therapy serves both cosmetic and medical purposes, addressing skin issues like acne, fine lines, and psoriasis, while also aiding pain management, wound healing, and other conditions. 

FDA-cleared for aesthetic use, it is typically a complementary therapy, requiring professional guidance for safe and effective application.

Having a doctor’s prescription can play a key role in making red light therapy (RLT) eligible for insurance coverage, but it doesn’t guarantee it. 

Most insurance companies require proof of medical necessity, which means a formal diagnosis from your doctor, a prescription, and detailed documentation explaining why RLT is essential for your treatment. 

This documentation should outline how the therapy helps improve your specific condition and include a treatment plan, progress notes, and measurable outcomes.

However, it’s important to note that red light therapy is generally not a standard covered treatment. 

Coverage varies by provider, and even with a prescription, insurers may still deny claims. 

If coverage is considered, you may also need ongoing treatments one to three times a week, sometimes for weeks or months, and the wavelength of the device used can affect results. 

Checking with your insurance beforehand and keeping thorough medical records is crucial to maximize your chances of reimbursement.

To check if insurance covers red light therapy, contact your provider or member portal, confirm if it’s medically necessary, obtain a Letter of Medical Necessity, use the correct CPT code (e.g., 97026), and secure preauthorization, as coverage often depends on diagnosis, provider type, and thorough documentation.

• At-Home Devices: Cheaper red light devices are available for personal use.
  
  

• LED Masks & Gadgets: Handheld or mask-style LED tools work as budget-friendly options.
  
  

• Sunlight Exposure: Regular sunlight can provide similar benefits for free.
  
  

• Gyms & Spas: Some gyms and spas offer light therapy sessions at lower costs.
  
  

• Other Therapies: Alternative affordable treatments may help with pain and skin issues.