Medicare AdvantageAdministrativeLow impact
MA07.030c, Photodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)
Independence Blue Cross·NJ · Gastroenterology, Pulmonology, Oncology +2 more·Pharmacy
We identified it
Jun 19, 2026
Summary
This is an annual policy reissue with no substantive changes to coverage criteria for Photodynamic Therapy using Porfimer Sodium (Photofrin®). The policy was reissued on 07/09/2025 in accordance with Independence Blue Cross's standard annual review process. No updates to covered indications, billing codes, or medical necessity criteria have been made.
Action Required
No immediate action required. This is a policy reissue with no changes. Billing teams should verify that current systems accurately reflect the covered indications listed in the policy (Barrett's esophagus HGD ablation, esophageal cancer palliation, cholangiocarcinoma palliation, endobronchial NSCLC treatment, and superficial skin cancers). Ensure prior authorizations continue to be requested for PDT claims when applicable under the Independence Blue Cross Medicare Advantage plan terms. No workflow modifications are necessary.