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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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