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Blue Cross & Blue Shield of MississippiAll Plans · Billing Codes · Medical Policy · Dermatology, OncologyMedium impact

Dermatologic Applications of Photodynamic Therapy

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Photodynamic therapy may be considered medically necessary for non-hyperkeratotic actinic keratoses of the face and scalp, non-hyperkeratotic actinic keratoses of the upper extremities, low-risk (eg superficial and nodular) basal cell skin cancer only when surgery and radiation are contraindicated, and cutaneous squamous cell carcinoma in situ (Bowen disease) only when surgery and radiation are contraindicated. It is investigational for other dermatologic uses, including acne vulgaris, high-risk basal cell carcinomas, hidradenitis suppurativa, and mycoses, and for skin rejuvenation, hair removal, or other cosmetic indications. The 05/29/2026 update reviewed the policy with the policy statements unchanged and updated the code reference to note the deleted HCPCS code J7309.

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What to do

Action · 6 steps
01Billing team: For non-hyperkeratotic actinic keratoses, document 4 or more lesions per site on the face, scalp, or upper extremities, which the policy describes as the appropriate threshold for use of photodynamic therapy.
02For low-risk basal cell skin cancer and Bowen disease, document that surgery and radiation are contraindicated, since the policy covers photodynamic therapy for these only in that case.
03Report CPT 96567 or 96573 for photodynamic therapy as applicable, and CPT 96574 when a premalignant hyperkeratotic lesion is debrided before the photodynamic therapy.
04Do not bill a separate Evaluation and Management code for the second office visit that is performed solely to administer blue light.
05Plan for the typical protocol of 2 treatments spaced a week apart, since more than one treatment series may be required.
06Do not report HCPCS J7309 (methyl aminolevulinate), which the code reference lists as deleted 12/31/2025.

Codes mentioned

965679657396574J7308J7309J7345L57.0

Original notice

Dermatologic Applications of Photodynamic Therapy
bcbsms.com · Always check the source before changing claims.
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Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
DermabrasionMediumEffective Feb 5, 2026 · Medical PolicyChemical PeelsMediumNo effective date · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesDermatologyOncologyCode 96567Code 96573Code 96574Code J7308Code J7309Code J7345Code L57.0

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