Medicare AdvantageBilling CodesMedium 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
Independence Blue Cross reissued MA07.003f with no substantive changes to photodynamic therapy (PDT) using verteporfin coverage criteria, but removed 15 ICD-10 diagnosis codes that are no longer covered. The policy aligns with CMS NCDs and remains effective 02/02/2026. Billing teams must remove deleted diagnosis codes from claims to prevent denials.
Action Required
By 02/02/2026: Billing team must update claims processing system to reject or flag any PDT claims (CPT 67221, 67225) submitted with the following deleted ICD-10 diagnosis codes: 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-H44.2E9. Remove these codes from diagnosis code libraries and encounter templates used by ophthalmology providers. Verify that only the retained ICD-10 codes (H35.051, H35.052, H35.053, H35.3210-H35.3213, and other active AMD/CNV codes) are used for PDT authorization and billing. Communicate to all ophthalmology providers that claims using deleted diagnosis codes will be denied by Independence Blue Cross Medicare Advantage plans.