CommercialBilling CodesLow impact
07.00.10j, Photodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)
Independence Blue Cross·Gastroenterology, Oncology, Pulmonology +2 more·Pharmacy
Effective date
Jul 9, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued PDT policy 07.00.10j on 07/09/2025 with no substantive changes to coverage criteria. Three CPT codes (96567, 96573, 96999) were added and four ICD-10 diagnosis codes (C23, D13.0, D37.8, D37.9) were removed. The policy maintains coverage for PDT using porfimer sodium for Barrett's esophagus, esophageal cancer, cholangiocarcinoma, endobronchial lung cancer, and specific skin conditions.
Action Required
By 07/09/2025: Billing team should verify that the three newly added CPT codes (96567, 96573, 96999) are active and properly linked in the billing system for PDT claims. Remove the four deleted ICD-10 diagnosis codes (C23, D13.0, D37.8, D37.9) from any automated claim editing or pre-population templates to prevent inappropriate claim submissions. No changes to coverage determinations or prior authorization requirements are needed, as this is a reissue with no substantive policy changes.