ICD-10 H35.3210 is officially defined as "Exudative age-related macular degeneration, right eye, stage unspecified." code H35.3210 is referenced in 8 tracked payer policy changes from Independence Blue Cross, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code H35.3210 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Independence Blue Cross reissued MA07.003f with no substantive changes to photodynamic therapy (PDT) using verteporfin coverage criteria, but removed 15 ICD-10 diagnosis codes that are no longer covered. The policy aligns with CMS NCDs and remains effective 02/02/2026. Billing teams must remove deleted diagnosis codes from claims to prevent denials.
Independence Blue Cross reissued MA07.003f on 02/02/2026 with no substantive changes to photodynamic therapy coverage criteria, but removed 15 ICD-10 diagnosis codes that are no longer covered under this policy. The policy aligns with CMS National Coverage Determinations (NCDs) for verteporfin PDT treatment of choroidal neovascularization associated with AMD, presumed ocular histoplasmosis, and pathologic myopia. Billing teams must remove the deleted ICD-10 codes from claim submission logic to prevent denials.
Independence Blue Cross Medicare Advantage reissued policy MA07.003f for photodynamic therapy using verteporfin (Visudyne) with no substantive changes to coverage criteria. However, 15 ICD-10 diagnosis codes were removed from the policy effective 02/02/2026, which may affect claim submissions for certain retinal and ocular conditions. Billing teams must verify that submitted claims use only the ICD-10 codes currently listed in the policy to avoid denials.
Independence Blue Cross reissued Policy 07.13.05m on its existing terms with no substantive changes to PDT verteporfin coverage criteria. However, 12 ICD-10 diagnosis codes were removed effective 11/17/2025, which may affect claim submissions for certain macular degeneration and choroidal conditions. Billing teams must verify that claims use only the diagnosis codes now listed in the policy to avoid denials.
Independence Blue Cross reissued policy 07.13.05m on photodynamic therapy (PDT) using verteporfin with no substantive changes to coverage criteria. However, 12 ICD-10 diagnosis codes were removed effective 11/17/2025, which may affect claims processing for certain ocular conditions. Billing teams must verify that claims for PDT use only the ICD-10 codes listed in the current policy to avoid denials.
Autologous skeletal myoblast transplantation, intra-coronary and intra-myocardial autologous bone marrow cell transplantation, and intra-arterial or intra-muscular autologous mononuclear bone marrow cell transplantation are considered experimental, investigational, or unproven because effectiveness has not been established. Autologous or allogeneic bone marrow-derived mesenchymal stem cell transplantation is likewise considered experimental, investigational, or unproven for conditions including acute myocardial infarction, diabetes, multiple sclerosis, knee osteoarthritis, spinal cord injury, rheumatoid arthritis, Crohn's disease, and peripheral nerve repair. CPT codes 0263T, 0264T, 0265T, 38240, and 38241 and HCPCS code C9782 are listed as not covered for the listed indications, and the ICD-10 codes for those indications are listed as not covered for these services.
Aetna considers brachytherapy medically necessary for breast, esophageal, eye tumors, genitourinary cancers other than bladder, gynecologic, head and neck, respiratory and digestive tract, and soft tissue sarcoma indications when the EviCore Healthcare Radiation Therapy Clinical Guidelines criteria are met. It also considers brachytherapy medically necessary for skin cancer where surgical resection and photon or electron beam techniques are contraindicated, and for stenotic obstruction after lung transplantation refractory to other treatments. Brachytherapy for bladder cancer, bone metastases, brain tumors, leukemia, lymphoma, multiple myeloma, pancreatic cancer, keloids, palmoplantar pustulosis, spinal tumors and spinal metastases, and subfoveal choroidal neovascularization secondary to age-related macular degeneration is considered experimental, investigational or unproven, and electronic brachytherapy is considered experimental, investigational or unproven for breast cancer and all other indications.
BCBSMS considers verteporfin photodynamic therapy as monotherapy medically necessary for choroidal neovascularization associated with age-related macular degeneration, pathologic myopia, presumed ocular histoplasmosis, chronic central serous chorioretinopathy, or choroidal hemangioma. Verteporfin photodynamic therapy as monotherapy for other ophthalmologic disorders is considered investigational. Verteporfin photodynamic therapy combined with ranibizumab, bevacizumab, aflibercept, brolucizumab-dbll or faricimab-svoa is also considered investigational.
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