Photodynamic Therapy Policy
Defines medical necessity and nonmedical necessity coverage for photodynamic therapy (PDT) for dermatologic indications, lists applicable procedure and drug codes, and provides supporting background/evidence. Applies to commercial products of Blue Cross Blue Shield - Rhode Island.
Policy statement specifies medically necessary indications (nonhyperkeratotic actinic keratoses of face and scalp; superficial BCC and Bowen disease when surgery and radiation contraindicated) and lists other dermatologic uses as not medically necessary.
Coverage Summary
This policy defines coverage for photodynamic therapy (PDT) for dermatologic conditions under Blue Cross Blue Shield of Rhode Island commercial products and specifies when PDT is considered medically necessary or not medically necessary.
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