Medicare AdvantageCoverageHigh impact
MA06.001g, Apheresis Therapy
Independence Blue Cross·Pulmonology, Transplant Surgery, Critical Care +2 more·Medical Policy
Effective date
Jun 8, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage has significantly restricted coverage for extracorporeal photopheresis (ECP) therapy. ECP is now covered ONLY for bronchiolitis obliterans syndrome (BOS) following lung transplant when refractory to standard immunosuppressive therapy AND enrolled in a Medicare-approved clinical study under Coverage with Evidence Development (CED). Previous coverage for other chronic lung allograft dysfunctions (CLAD, RAS) has been removed. CPT code 90997 has been newly added as medically necessary.
Action Required
By June 8, 2026: (1) Billing team must update system rules to restrict ECP billing (CPT 36522) - it is now ONLY covered for BOS post-lung transplant under Medicare CED programs; deny claims for other CLAD/RAS indications. (2) Add CPT 90997 (hemoperfusion) to medically necessary codes in billing software. (3) Add ICD-10 codes J44.81 (BOS) and Z00.6 (clinical research encounter) as eligible diagnosis codes ONLY when billed together under Medicare CED. (4) Providers and authorization staff must verify patient enrollment in a Medicare-approved clinical study BEFORE submitting ECP claims; claims without proof of CED enrollment will be denied. (5) Update clinical documentation requirements to mandate notation of CED study enrollment and refractory status to standard immunosuppressive therapy. (6) Communicate restriction to pulmonology, transplant surgery, and critical care teams - prior approvals for ECP outside BOS/CED will no longer be granted.