Medicare AdvantageCoverageMedium impact
MA07.003f, Photodynamic Therapy Using Verteporfin (Visudyne®)
Independence Blue Cross·Ophthalmology·Pharmacy
Effective date
Feb 2, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated their policy for Photodynamic Therapy Using Verteporfin (Visudyne®) affecting coverage positions, medical necessity criteria, and coding requirements. This pharmacy policy change includes updates to general guidelines and informational content.
Action Required
Before February 2, 2026: Billing team must review updated MA07.003f policy at https://medpolicy.ibx.com for changes to coverage criteria, medical necessity requirements, and coding guidelines for Photodynamic Therapy using Verteporfin. Update prior authorization processes and billing protocols accordingly. Providers should review new medical necessity criteria to ensure proper documentation.