CommercialBilling CodesMedium impact
07.13.05m, Photodynamic Therapy (PDT) Using Verteporfin (Visudyne®)
Independence Blue Cross·PA · Ophthalmology, Pharmacy·Pharmacy
Effective date
Nov 17, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued policy 07.13.05m on photodynamic therapy (PDT) using verteporfin with no substantive changes to coverage criteria. However, 12 ICD-10 diagnosis codes were removed effective 11/17/2025, which may affect claims processing for certain ocular conditions. Billing teams must verify that claims for PDT use only the ICD-10 codes listed in the current policy to avoid denials.
Action Required
By November 17, 2025: Billing team must remove the following ICD-10 diagnosis codes from PDT verteporfin claim submissions: H35.059, H35.3290, H35.3291, H35.3292, H35.3293, H35.719, H44.20, H44.2A9, H44.2B9, H44.2C9, H44.2D9, H44.2E9. Update billing system rules and encounter templates to prevent use of these codes with CPT 67221 and 67225. Ensure providers use only supported diagnosis codes from the current policy (B39.3-B39.9, D18.09, H32, H35.051-H35.053, H35.3210, etc.). Verify all pending claims for PDT do not contain the removed codes; resubmit with valid codes if necessary. Claims submitted with removed ICD-10 codes will be denied for not meeting medical necessity criteria.