Medicare AdvantageCoverageMedium impact
MA07.003f, Photodynamic Therapy Using Verteporfin (Visudyne®)
Independence Blue Cross·Ophthalmology, Oncology·Pharmacy
Effective date
Feb 2, 2026
We identified it
Jun 19, 2026
Summary
Policy MA07.003f regarding Photodynamic Therapy Using Verteporfin (Visudyne®) has been updated with changes to coverage criteria, reimbursement position, medical necessity requirements, and/or billing codes effective February 2, 2026. The billing team must review the full policy details to identify specific coverage and coding changes that may affect claim submission and authorization processes.
Action Required
By February 2, 2026: Billing team must obtain and review the complete policy text at https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=02&FilterField2=MPSiteActivityLogYear&FilterValue2=2026#medicare-advantage-ma07-003f-photodynamic-therapy-using-vert to identify specific CPT/HCPCS codes, medical necessity criteria, and prior authorization requirements for Verteporfin photodynamic therapy claims. Update billing system rules, prior authorization workflows, and encounter documentation templates accordingly. Communicate changes to providers and ensure all claims submitted on or after the effective date comply with new requirements. Failure to implement updates may result in claim denials for non-compliance with medical necessity criteria.