Medicare AdvantageDocumentationMedium impact
MA07.056e, Photodynamic Therapy (PDT) Using Levulan® Kerastick® or Ameluz® (Aminolevulinic Acid HCl [ALA])
Independence Blue Cross·Dermatology, Oncology·Pharmacy
Effective date
Oct 20, 2025
We identified it
Jun 19, 2026
Summary
Policy MA07.056e has been updated with changes to medical necessity criteria, medical coding, and general guidelines for Photodynamic Therapy (PDT) using Levulan® Kerastick® or Ameluz® (Aminolevulinic Acid HCl [ALA]). The billing team must review updated coverage requirements and coding guidelines to ensure compliant claim submission effective October 20, 2025.
Action Required
By October 20, 2025: Billing team must obtain and review the complete MA07.056e policy document to identify specific changes to medical necessity criteria and medical coding requirements for PDT procedures using Levulan® Kerastick® or Ameluz®. Update billing system rules, prior authorization workflows, and provider documentation templates to reflect new medical necessity requirements. Train billing staff on coding changes and ensure all PDT claims submitted after the effective date comply with updated guidelines. Contact the policy source (IBX) if specific codes or requirements are unclear. Failure to implement changes may result in claim denials for non-compliant submissions.