CommercialCoverageMedium impact
06.03.04p, Apheresis Therapy
Independence Blue Cross·Transplant Surgery, Pulmonology, Pathology +1 more·Medical Policy
Effective date
Jun 8, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy 06.03.04p to reclassify extracorporeal photopheresis (ECP) treatment for chronic lung allograft dysfunction (CLAD), bronchiolitis obliterans syndrome (BOS), and restrictive allograft syndrome (RAS) from medically necessary to experimental/investigational, effective 06/08/2026. CPT code 90997 (Hemoperfusion) was added to the medically necessary list. Billing teams must stop covering ECP for these lung transplant indications after the effective date and update system rules accordingly.
Action Required
By 06/08/2026: Billing team must update billing system and medical necessity rules to reclassify extracorporeal photopheresis (CPT 36522) for chronic lung allograft dysfunction (CLAD), bronchiolitis obliterans syndrome (BOS), and restrictive allograft syndrome (RAS) from covered to experimental/investigational. Add CPT 90997 (Hemoperfusion) to medically necessary procedures. Update prior authorization logic to deny or route ECP claims for these indications to experimental review process. Notify providers and prior authorization staff of the change. Claims submitted after 06/08/2026 for ECP treatment of lung allograft rejection conditions will be denied as not medically necessary unless submitted through experimental/investigational review channel.