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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