CommercialCoverageMedium impact
06.03.04p, Apheresis Therapy
Independence Blue Cross·Hematology, Nephrology, Neurology +5 more·Medical Policy
Effective date
Jun 8, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy 06.03.04p effective 06/08/2026 to reclassify extracorporeal photophoresis (ECP) treatment for chronic lung allograft dysfunction (CLAD), including bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS), from medically necessary to experimental/investigational. Additionally, CPT code 90997 (Hemoperfusion) was added to the medically necessary coverage list.
Action Required
By June 8, 2026: Billing team must update billing system and coding guidelines to reflect that CPT code 90997 (Hemoperfusion) is now medically necessary and covered. Additionally, billing staff must be trained to deny or reclassify any claims for extracorporeal photopheresis (ECP) treatment for chronic lung allograft dysfunction (CLAD), bronchiolitis obliterans syndrome (BOS), or restrictive allograft syndrome (RAS) as experimental/investigational, requiring prior authorization or denial depending on plan terms. Update authorization rules in the system to prevent automatic approval of ECP claims for these lung transplant conditions. Flag any pending or appealed claims involving ECP for lung allograft dysfunction for review and reclassification.