CommercialCoverageMedium impact
07.00.10j, Photodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)
Independence Blue Cross·Oncology, Dermatology·Pharmacy
Effective date
Jul 9, 2025
We identified it
Jun 19, 2026
Summary
This is a reissue of the existing policy on Photodynamic Therapy (PDT) using Porfimer Sodium (Photofrin®), effective July 9, 2025. The policy governs coverage, medical necessity criteria, and billing requirements for PDT procedures. The billing team should review the full policy text to identify any substantive changes from the previous version and update internal protocols accordingly.
Action Required
By July 9, 2025: Billing team must access and review the complete policy text at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=07&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-07-00-10j to identify specific billing code changes, prior authorization requirements, and coverage criteria for PDT using Porfimer Sodium. Update billing system rules, prior authorization workflows, and provider documentation requirements based on policy specifics. Communicate any changes to providers and front desk staff. Without access to the full policy text, specific billing codes and requirements cannot be extracted from the summary provided.