Is Photodynamic Therapy Covered by Insurance?

Doctor Answers (9)

PDT and Insurance

+1

Sometimes PDT is covered by your insurance. It is a useful procedure for treating  pre-skin cancers, sebaceaous hyperplasia, acne and skin re-juvenation. With the proper codes it may cover the treatments for pre-skin cancers. Each insurance  company and policy is different so it is best if you check with your insurance sompany.


Houston Dermatologic Surgeon
5.0 out of 5 stars 17 reviews

Photodynamic therapy

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In Toronto, for photodynamic therapy the levulan (ALA) can be often be covered by insurance, however the cost of the Blu-light treatment is usually not covered

Anatoli Freiman, MD
Toronto Dermatologist
5.0 out of 5 stars 4 reviews

Insurance Coverage for Photodynamic Therapy (PDT)

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Many insurances cover PDT for actinic keratosis - precancerous skin lesion, but not for acne, sebaceous hyperplasia, oily skin, and photodamaged skin. Please, check with your insurance provider for further details if you are desiring PDT for actinic keratosis, prior authorization may be needed before you have the procedure performed.

Jennifer Peterson, MD
Houston Dermatologist
5.0 out of 5 stars 12 reviews

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PDT and insurance

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It's only covered for actinic keratosis (precancersous growths). It's not covered for things like ace, elnlarged pores and sebaceous (oil) glands, etc.

Gary Goldenberg, MD
New York Dermatologist

PDT may be covered by insurance

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Depending on the diagnosis, Photodynamic therapy may be covered.  Treatment of actinic keratoses, not acne, may be covered, and varies depending on your insurance carrier.  Factors such as your deductible and time between treatments may also affect how your insurance company ultimately covers the procedure.  You should contact your insurance carrier for definite answers, and have ICD-9 diagnosis codes ready--these can be obtained from your treating physician's office.

Melanie D. Palm, MD
San Diego Dermatologic Surgeon
5.0 out of 5 stars 12 reviews

PDT is usually covered for precancer, not for rejuvenation

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Photodynamic Therapy (PDT) is an excellent treatment for pre-cancerous actinic keratoses (AKs) and is covered by insurance for such.  There is an added cosmetic benefit in these patients of skin rejuvenation, which has given PDT great popularity in dermatology practices. 

Michael Howard Swann, MD
Springfield Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

Photodynamic Therapy is only covered for pre-skin cancer.

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Photodynamic therapy is only covered for the treatment of actinic keratoses, or pre-skin cancers.  It is not covered for rejuvenation of the skin or for acne.  Even when it is covered for actinic keratoses, the reimbursements may vary between insurance companies as well as have restrictions, like where the AKs are located and how many there are.

Amy Forman Taub, MD
Chicago Dermatologic Surgeon
4.0 out of 5 stars 7 reviews

Photodynamic Therapy Covered for Medically Necessary Treatments

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Patients who have a large amount of sun damage, and have been treated with localized treatments options such as liquid nitrogen (cryotherapy) may be candidates for PDT which will be covered by most insurance providers.  Your dermatologist should be able to help you with this issue.

Thomas W. Bender, III MD
Mobile Dermatologic Surgeon
5.0 out of 5 stars 2 reviews

Cosmetic procedures are often not covered by insurance.

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Although all insurance companies have different guidelines, cosmetic procedures are usually not covered.  You can obtain a letter of predetermindation from your insurance to see if you are eligible for coverage for your desired treatment.  If you are wishing to use Photodynamic Therapy for cancer related issues, it may be covered. 

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 48 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.