Policy 8.01.01 considers extracorporeal photopheresis medically appropriate for palliative treatment of skin manifestations of cutaneous T-cell lymphoma or Sézary syndrome that have not responded to other therapy, for acute and chronic extensive graft-versus-host disease refractory to conventional therapy, and for recurrent or refractory cardiac allograft rejection. Photopheresis is considered investigational for all other indications, including GVHD in previously untreated patients or those responding to conventional therapy, scleroderma, autoimmune diseases, Crohn's disease, solid organ allograft rejection other than the heart, and diabetes mellitus. The current effective date is October 22, 2026, and the 10/22/26 annual review left the policy intent unchanged.
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01Already effective 2026-10-22: Billing team: Use CPT 36522 (photopheresis, extracorporeal) for the indications in Policy Statement I.
02Billing team: The ICD-10 codes listed in the policy include mycosis fungoides (C84.00-C84.09), Sézary disease (C84.10-C84.19), graft-versus-host disease (D89.810-D89.813), and complications of bone marrow, heart and heart-lung transplants (T86.00-T86.09 and T86.20-T86.39).
03Billing team: Treatment of GVHD and autoimmune disease is an off-label use of the FDA-approved photopheresis systems, which are approved for palliative treatment of CTCL skin manifestations in persons not responsive to other forms of treatment.
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