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Dermatologic Applications of Photodynamic Therapy
Blue Cross & Blue Shield of Mississippi·MS · Dermatology·Medical Policy
We identified it
Jun 20, 2026
Summary
This policy update establishes coverage criteria for Photodynamic Therapy (PDT) for dermatologic conditions. PDT is considered medically necessary for non-hyperkeratotic actinic keratoses of the face, scalp, and upper extremities, as well as low-risk basal cell cancer and cutaneous squamous cell carcinoma in situ when surgery and radiation are contraindicated.
Action Required
Immediately: Billing team must ensure PDT claims include proper documentation showing medical necessity criteria are met. For actinic keratoses, verify patient has 4 or more lesions per site (face, scalp, or upper extremities). For basal cell cancer and Bowen disease, document contraindications to surgery and radiation. Update billing protocols to reflect that the second office visit for blue light exposure should not include a separate E&M code.