Chapter 4
Section 9.2
Photopheresis
Issue Date: June 30, 1993
Copyright: CPT
only © 2006 American Medical Association (or such other date of
publication of CPT).
All Rights Reserved.
Revision:
1.0 CPT
PROCEDURE CODE
36522
2.0 DESCRIPTION
Photopheresis is a type of plasmapheresis during
which white blood cells and some plasma is exposed to Ultraviolet
(UV) light before being returned to the patient.
3.0 POLICY
Photopheresis is covered for the following:
3.1 The treatment
of skin manifestations of Cutaneous T-Cell Lymphoma (CTCL) in persons
who have not been responsive to other forms of treatment.
3.2 The prevention
of rejection in cardiac transplantation.
3.3 Extracorporeal photopheresis
for the treatment of Bronchiolitis Obliterans Syndrome (BOS) that is
refractory to immunosuppressive drug treatment may be considered
for cost-sharing under the rare disease policy as described in
Chapter 1, Section 3.1.
3.4 For other
indications when reliable evidence supports that photopheresis is
safe, effective and comparable or superior to standard care (proven).
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