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Medical Policy Revision: Dermatologic Applications of Photodynamic Therapy

Effective August 6, 2019, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims based on revisions to our medical policy, Dermatologic Applications of Photodynamic Therapy.

Access our Medical Policy Manual to review this medical policy content.¹


Claims submitted for services provided on and after August 6, 2019 to patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO) or Medicare Advantage (MA) plans will be processed as follows.

  • Based on the submitted diagnosis code(s), we may request information to help determine the medical appropriateness of the services represented by CPT® codes 96567, 96573, 96574 or HCPCS code J7308, J7309, J7345. Following our review of medical record information, the services represented by these codes may be denied as not medically necessary or as experimental/investigational, non-covered services.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been canceled or postponed, the changes will be applied to claims for dates of service on and after August 6, 2019.

CPT® is a registered mark of the American Medical Association.

Published on: May 7, 2019, 11:03 a.m. ET
Last updated on: May 7, 2019, 11:09 a.m. ET