CommercialBilling CodesMedium impact
07.13.05m, Photodynamic Therapy (PDT) Using Verteporfin (Visudyne®)
Independence Blue Cross·Ophthalmology, Pharmacy·Pharmacy
Effective date
Nov 17, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued Policy 07.13.05m on its existing terms with no substantive changes to PDT verteporfin coverage criteria. However, 12 ICD-10 diagnosis codes were removed effective 11/17/2025, which may affect claim submissions for certain macular degeneration and choroidal conditions. Billing teams must verify that claims use only the diagnosis codes now listed in the policy to avoid denials.
Action Required
By 11/17/2025: Billing team must audit all claims currently using the 12 removed ICD-10 diagnosis codes (H35.059, H35.3290, H35.3291, H35.3292, H35.3293, H35.719, H44.20, H44.2A9, H44.2B9, H44.2C9, H44.2D9, H44.2E9) for PDT verteporfin procedures. Update billing software to remove these codes from the approved list for CPT 67221 and 67225. Providers must re-code any pending or future PDT claims using only the diagnosis codes explicitly listed in the current policy (B39.3-B39.9, D18.09, H32, H35.051-H35.053, H35.3210, and others specified in the full policy). Notify clinical staff that claims submitted with removed diagnosis codes will be denied. Maintain documentation showing compliance with code transition by 11/17/2025 effective date.