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AetnaAll Plans · Coverage · Medical Policy · Dermatology, Oncology, Hematology +2 moreMedium impact

Extracorporeal Photochemotherapy (Photopheresis) (CPB 0241, reviewed 2026-04-13)

Effective date
Not stated in the notice
Identified
Aug 15, 2026

Summary

Aetna considers extracorporeal photochemotherapy (photopheresis, ECP) medically necessary for erythrodermic variants of cutaneous T cell lymphoma, acute cardiac allograft rejection refractory to standard immunosuppressive drug treatment, bronchiolitis obliterans rejection in lung transplants that is refractory to immunosuppressive drug treatment, rejection of other solid organ transplants as a last resort, and graft-versus-host disease after an allogeneic bone marrow or stem cell transplant that is refractory to standard immunosuppressive drug treatment. Aetna considers photopheresis experimental, investigational, or unproven for many other conditions, including atopic dermatitis, multiple sclerosis, Crohn's disease, systemic sclerosis, and type 1 diabetes. Prophylaxis of graft-versus-host disease following allogeneic hematopoietic cell transplantation is also listed as experimental, investigational, or unproven.

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What to do

Action · 5 steps
01Billing team: Bill CPT 36522 (photopheresis, extracorporeal) only when the selection criteria are met, and pair it with the ICD-10 codes the source lists as covered when criteria are met, including C84.00-C84.09, C84.10-C84.19, C84.A0-C84.A9, D89.810-D89.813, J42, T86 transplant complication codes, Z94.1, and Z94.81.
02J42 is covered only for rejection (bronchiolitis obliterans) in lung transplants and is not covered for bronchiolitis obliterans syndrome after allogeneic stem cell transplantation.
03Cardiac allograft rejection qualifies only when it is resistant or dependent to high-dose steroids and refractory to 2 or more of azathioprine, cyclosporine, methotrexate, and/or antilymphocyte agents, unless contraindicated.
04Lung transplant rejection qualifies when it is resistant to high-dose steroids and to 2 or more of azathioprine, cyclosporine, tacrolimus, and/or antilymphocyte agents, unless contraindicated, or when there is a rapid decline in lung function.
05Confirm the diagnosis is on the covered list, since Aetna considers the other listed conditions experimental, investigational, or unproven.

Codes mentioned

36522J42Z94.1Z94.81

Original notice

Extracorporeal Photochemotherapy (Photopheresis) (CPB 0241, reviewed 2026-04-13)
aetna.com · Always check the source before changing claims.
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