Medicare AdvantageCoverageHigh impact
MA06.001g, Apheresis Therapy
Independence Blue Cross·Transplant Surgery, Pulmonology, Critical Care·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) treatment of chronic lung allograft dysfunction. 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). All other indications (restrictive allograft syndrome and non-refractory BOS) are no longer covered. CPT code 90997 (hemoperfusion) has been added as medically necessary.
Action Required
By June 8, 2026: Billing team must update claim submission protocols and prior authorization workflows. (1) STOP covering ECP (CPT 36522) for restrictive allograft syndrome (RAS) and non-refractory BOS—these claims will be denied. (2) For BOS cases, verify patient enrollment in a Medicare-approved clinical study BEFORE submitting claims; require CED documentation. (3) Update system templates to require ICD-10 J44.81 with Z00.6 when submitting ECP claims for study participants. (4) Ensure CPT 90997 is recognized as medically necessary in billing software. (5) Notify transplant pulmonology and thoracic surgery providers of coverage restrictions and clinical trial requirement. (6) Implement internal review process to audit ECP claims for compliance with CED enrollment criteria. Non-compliant claims will be denied and subject to recoupment.