Medicare AdvantageCoverageMedium impact
MA07.056f, Photodynamic Therapy (PDT) Using Levulan® Kerastick® or Ameluz® (Aminolevulinic Acid HCl [ALA])
Independence Blue Cross·MA · Dermatology, Oncology·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
This is a new Medicare Advantage policy (effective 01/01/2026) establishing coverage guidelines for Photodynamic Therapy (PDT) using Levulan® Kerastick® or Ameluz® (Aminolevulinic Acid HCl [ALA]). The billing team must review the full policy text to identify specific coverage criteria, prior authorization requirements, and applicable billing codes to ensure compliant claim submission.
Action Required
By 01/01/2026: Billing team must obtain and review the full policy text at the provided URL to identify: (1) specific CPT/HCPCS codes for PDT procedures and drug administration, (2) prior authorization requirements, (3) medical necessity criteria, and (4) any coverage restrictions. Update billing software, encounter forms, and provider documentation templates accordingly. Ensure all PDT claims for Levulan® Kerastick® or Ameluz® submitted on or after 01/01/2026 comply with MA07.056f requirements. Claims submitted without adherence to new guidelines will be denied.