95905 Insurance Policy Changes

Atidarsagene Autotemcel (Lenmeldy) (CPB 1058, reviewed 2026-07-13)

Aetna has established a new clinical policy (CPB 1058) for Lenmeldy (atidarsagene autotemcel), a gene therapy for metachromatic leukodystrophy. The policy requires precertification for all commercial plans, mandates treatment at Aetna GCIT Network facilities, and establishes strict medical necessity criteria including diagnosis confirmation, genetic testing, infectious disease screening, and 15-year post-treatment monitoring. Billing teams must implement prior authorization processes and ensure claims are routed through designated network providers.