One or more courses of photodynamic therapy may be considered medically necessary for the following oncologic applications:
palliative treatment of obstructing esophageal cancer
palliative treatment of obstructing endobronchial lesions
treatment of early-stage non-small-cell lung cancer in patients who are ineligible for surgery and radiotherapy
treatment of high-grade dysplasia in Barrett esophagus
palliative treatment of unresectable cholangiocarcinoma when used with stenting.
Other oncologic applications of photodynamic therapy are investigational including, but not limited to, other malignancies and Barrett esophagus without associated high-grade dysplasia.
