Photodynamic Therapy (CPB 0375, reviewed 2026-05-21)
Summary
Aetna considers photodynamic therapy with porfimer sodium (Photofrin) medically necessary for esophageal cancer, endobronchial non-small cell lung cancer and inoperable cholangiocarcinoma (as an adjunct to stenting) when the listed criteria are met, and experimental, investigational or unproven when they are not. Photodynamic therapy with topical photosensitizers such as methyl aminolevulinate, topical 5-fluorouracil and aminolevulinic acid is medically necessary for basal cell carcinoma, cutaneous lesions of Bowen's disease, refractory actinic keratoses, low-risk squamous cell carcinoma in situ where surgery or radiation is contraindicated or impractical, and erythroplasia of Queyrat. Photodynamic therapy is considered experimental, investigational or unproven for other cancers and for a long list of non-cancer indications, and the policy applies to commercial medical plans.
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