CommercialCoverageMedium impact
07.07.03n, Photodynamic Therapy (PDT) Using Levulan® Kerastick® or Ameluz® (Aminolevulinic Acid HCl [ALA])
Independence Blue Cross·Dermatology, Oncology·Pharmacy
Effective date
Oct 20, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated PDT policy 07.07.03n to version 07.07.03o, effective 10/20/2025. Metvixia (methylaminolevulinate, HCPCS J7309) is no longer eligible for reimbursement due to market withdrawal. Eighteen ICD-10 diagnosis codes for basal cell and squamous cell carcinoma (C44 and D04 series) have been removed from covered diagnoses in Attachment A.
Action Required
By October 20, 2025: (1) Billing team must update billing system to DENY all claims for Metvixia (HCPCS J7309) with message 'Product no longer manufactured/market withdrawn.' (2) Remove the 18 deleted ICD-10 diagnosis codes (C44.101, C44.111, C44.121, C44.191, C44.201, C44.211, C44.221, C44.291, C44.601, C44.611, C44.621, C44.691, C44.701, C44.711, C44.721, C44.791, D04.10, D04.20, D04.60) from the system's coverage validation rules for PDT procedures. (3) Update encounter forms and provider education materials to clarify that only Levulan Kerastick (J7308, J7345) and Ameluz are eligible for reimbursement. (4) Providers must verify diagnosis codes at point of service; claims submitted with removed diagnoses will be denied. Contact IBX for Attachment A to confirm all covered diagnosis codes.