Medicare AdvantageBilling CodesMedium impact
MA07.056f, Photodynamic Therapy (PDT) Using Levulan® Kerastick® or Ameluz® (Aminolevulinic Acid HCl [ALA])
Independence Blue Cross·Dermatology, Oncology, Pharmacy·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage reissued policy MA07.056f on photodynamic therapy (PDT) with minor updates effective January 1, 2026. The primary change is the termination and removal of HCPCS code J7309 from the policy. Coverage criteria for PDT using Levulan Kerastick and Ameluz remain unchanged, covering field cancerization, actinic keratoses, squamous cell carcinoma in situ, and superficial basal cell carcinoma when surgery and radiation are contraindicated.
Action Required
By January 1, 2026: Billing team must remove HCPCS code J7309 from all billing systems, EMR templates, and fee schedules. Audit any pending or recent claims submitted with J7309 for Independence Blue Cross Medicare Advantage plans and correct them using valid replacement codes (J7308 or J7345 as appropriate). Update internal billing guidelines and staff training materials to reflect that J7309 is no longer valid for PDT services. Verify that claims processing software rejects or flags any future submission attempts using J7309 for this plan. Failure to remove this code will result in claim denials and potential compliance issues.