All PlansCoverageMedium impact
Photodynamic Therapy for Malignant Disease 8.01.06
Excellus BlueCross BlueShield·Oncology, Dermatology, Pulmonology +2 more·Cancer Treatment (Oncology)
Effective date
Feb 19, 2026
We identified it
Jun 20, 2026
Summary
This new policy establishes coverage criteria for Photodynamic Therapy (PDT) for malignant diseases, specifying medically appropriate uses including early-stage lung cancer, obstructing tumors, Barrett's dysplasia, and certain skin cancers. The policy also identifies contraindications and considers PDT investigational for most other cancer types.
Action Required
Before February 19, 2026: Billing team must review all PDT claims to ensure they meet the specific medical appropriateness criteria outlined in the policy. Update prior authorization processes to verify patients meet the approved indications (early-stage NSCLC, obstructing endobronchial/esophageal lesions, Barrett's HGD, unresectable cholangiocarcinoma, or specific skin cancers when surgery/radiation contraindicated). Flag any PDT requests for other cancer types as investigational and likely non-covered.