Medicare AdvantageCoverageMedium 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
Medicare Advantage updated their policy for Photodynamic Therapy (PDT) using Levulan Kerastick or Ameluz, with changes to medical necessity criteria, medical coding requirements, and general guidelines. This affects billing and coverage determination for PDT treatments.
Action Required
By October 20, 2025: Billing team must review updated medical necessity criteria and coding requirements for Photodynamic Therapy using Levulan Kerastick or Ameluz. Update prior authorization processes and documentation requirements in billing system according to new Medicare Advantage guidelines. Ensure providers are aware of updated criteria to prevent claim denials.