Blue Shield of CaliforniaAll Plans · Coverage · Medical Policy · CA · Oncology, Gastroenterology, PulmonologyHigh impact
Oncologic Applications of Photodynamic Therapy, Including Barrett Esophagus (8.01.06)
Effective date
Nov 1, 2026
Identified
Oct 31, 2026
Summary
Blue Shield of California updated its Oncologic Applications of Photodynamic Therapy, Including Barrett Esophagus policy (8.01.06), effective November 1, 2026. Appendix A shows that the statement on other oncologic applications, including Barrett esophagus without associated high-grade dysplasia, changed from investigational to considered not medically necessary, and the reference to other malignancies was removed from that statement. The policy still says photodynamic therapy may be considered medically necessary for palliative treatment of obstructing esophageal cancer and 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.
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01Already effective November 1, 2026: For photodynamic therapy, confirm the documented indication is one of the applications the policy lists as possibly medically necessary, because other oncologic applications, including Barrett esophagus without associated high-grade dysplasia, are considered not medically necessary.
02Provide the documentation Blue Shield lists for clinical review: history and physical and/or consultation notes including the reason for photodynamic therapy with the type and location of cancer, the reason surgery cannot or should not be used if applicable, documentation of curative intent, and previous treatments and response.
03For post-service review, also include the procedure report.
04Check current applicability of this policy at the source link.
Codes mentioned
31641432299657096571C9738J9600
Original notice
Oncologic Applications of Photodynamic Therapy, Including Barrett Esophagus (8.01.06)
blueshieldca.com · Always check the source before changing claims.
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