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Photodynamic Therapy for Choroidal Neovascularization
Blue Cross & Blue Shield of Mississippi·MS · Ophthalmology·Medical Policy
We identified it
Jun 20, 2026
Summary
This policy defines coverage criteria for verteporfin photodynamic therapy for choroidal neovascularization. The therapy is considered medically necessary as monotherapy for specific conditions (age-related macular degeneration, pathologic myopia, presumed ocular histoplasmosis, chronic central serous chorioretinopathy, choroidal hemangioma) but is investigational when combined with anti-VEGF therapies or for other ophthalmologic disorders.
Action Required
Billing team should review current verteporfin photodynamic therapy claims to ensure they align with the covered conditions listed in the policy. Verify that any combination therapy with anti-VEGF drugs is not being billed as covered, since these combinations are considered investigational. Update prior authorization processes to reflect the specific covered indications.