Photodynamic Therapy

Aetna covers porfimer sodium (Photofrin) PDT for select esophageal cancers (Barrett's carcinoma‑in‑situ/high‑grade disease in non‑surgical candidates, completely obstructing lesions, or partially obstructing lesions not amenable to Nd:YAG) and select endobronchial NSCLC (completely or partially obstructing, or microinvasive early‑stage when surgery/radiation are not indicated), and covers topical PDT (methyl aminolevulinate, aminolevulinic acid, topical 5‑FU) for basal cell carcinoma, Bowen's disease, refractory actinic keratoses, methyl aminolevulinate for low‑risk SCC in‑situ when surgery/radiation are contraindicated or impractical, and ALA/MAL for erythroplasia of Queyrat. PDT is considered experimental/investigational (and not covered) when the above criteria are not met, for other skin tumors, for IV photosensitizers for non‑melanoma skin tumors, and for cholangiocarcinoma.

"Aetna considers photodynamic therapy medically necessary as an adjunct to stenting for palliation of inoperable cholangiocarcinoma."