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Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Oncology, Pulmonology, GastroenterologyMedium impact

Oncologic Applications of Photodynamic Therapy, Including Barrett Esophagus

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

Summary

Photodynamic therapy may be considered medically necessary for palliative treatment of obstructing esophageal cancer, palliative treatment of obstructing endobronchial lesions, early-stage non-small-cell lung cancer in individuals ineligible for surgery and radiotherapy, high-grade dysplasia in Barrett esophagus, and palliative treatment of unresectable cholangiocarcinoma when used with stenting. Other oncologic applications, including Barrett esophagus without high-grade dysplasia, are investigational. The policy history records a 09/12/2025 description update, with policy guidelines updated regarding focal therapy.

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What to do

Action · 7 steps
01Billing team: Photodynamic therapy is medically necessary only for the applications listed in the policy.
02For Federal Employee Program (FEP) subscribers only, it may also be considered medically necessary for cholangiocarcinoma.
03For bronchoscopic photodynamic therapy, report code 31641 in addition to codes 96570 and 96571 as appropriate, and use codes 96570 and 96571 in conjunction with codes 31641 and 43229 as appropriate.
04Porfimer sodium is reported with HCPCS code J9600.
05For coding guidelines, see the Anesthesia Coding Policy.
06Other oncologic applications are investigational, and investigational services are not considered medically necessary.
07BCBSMS makes no payment for services that are not documented to be Medically Necessary.

Codes mentioned

31641965709657143229J9600C15.3C15.9C22.1C34.00C34.92C78.00C78.01C78.02C78.7C78.89D00.1D02.20D02.21D02.22K22.711

Original notice

Oncologic Applications of Photodynamic Therapy, Including Barrett Esophagus
bcbsms.com · Always check the source before changing claims.
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Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesOncologyPulmonologyGastroenterologyCode 31641Code 96570Code 96571Code 43229Code J9600Code C15.3Code C15.9Code C22.1Code C34.00Code C34.92Code C78.00Code C78.01Code C78.02Code C78.7Code C78.89Code D00.1Code D02.20Code D02.21Code D02.22Code K22.711

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