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Medicare AdvantageCoverageMedium impact

MA07.003f, Photodynamic Therapy Using Verteporfin (Visudyne®)

Independence Blue Cross·Ophthalmology, Pharmacy·Pharmacy
Effective date
Feb 2, 2026
We identified it
Jun 19, 2026
Days to comply
—

Summary

Independence Blue Cross Medicare Advantage reissued policy MA07.003f for photodynamic therapy using verteporfin (Visudyne) with no substantive changes to coverage criteria. However, 15 ICD-10 diagnosis codes were removed from the policy effective 02/02/2026, which may affect claim submissions for certain retinal and ocular conditions. Billing teams must verify that submitted claims use only the ICD-10 codes currently listed in the policy to avoid denials.

Action Required

Action needed
By 02/02/2026: Billing team must update claim submission guidelines to remove the following 15 ICD-10 diagnosis codes from photodynamic therapy claims: B39.3, B39.4, B39.5, B39.9, D18.09, H32, H35.059, H35.3290, H35.3291, H35.3292, H35.3293, H35.711, H35.712, H35.713, H35.719, H44.20, H44.21, H44.22, H44.23, H44.2A1, H44.2A2, H44.2A3, H44.2A9, H44.2B1, H44.2B2, H44.2B3, H44.2B9, H44.2C1, H44.2C2, H44.2C3, H44.2C9, H44.2D1, H44.2D2, H44.2D3, H44.2D9, H44.2E1, H44.2E2, H44.2E3, H44.2E9. Providers and billing staff must verify all verteporfin (CPT 67221, 67225) and J3396 claims use only approved diagnosis codes (H35.051-H35.053, H35.3210-H35.3213, and related codes per full policy). Update EMR templates and billing software validation rules to reject claims with removed codes. Claims submitted with removed diagnosis codes will be denied by Independence Blue Cross Medicare Advantage.

Affected Billing Codes

67221
67225
J3396
H35.051
H35.052
H35.053
H35.3210
H35.3211
H35.3212
H35.3213