ICD-10 N48.6 is officially defined as "Induration penis plastica." code N48.6 is referenced in 8 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code N48.6 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
BCBSMS revised its Xiaflex (collagenase clostridium histolyticum) criteria, effective 09/01/2025. Prior authorization is required, and a Dupuytren's contracture cord must have a contracture of at least 20 degrees with functional impairment in the hand and no surgical treatment on the selected joint within the last 90 days. Samples will not be considered current or stable therapy to satisfy Medical Policy requirements.
Aetna considers Xiaflex (collagenase clostridium histolyticum) medically necessary for commercial members with Dupuytren's contracture or Peyronie's disease when the initial criteria are met. For Dupuytren's contracture, the member needs a finger flexion contracture with a palpable cord in a metacarpophalangeal or proximal interphalangeal joint, a contracture of at least 20 degrees, a positive tabletop test, and up to 3 injections per cord 4 weeks apart. For Peyronie's disease, the member needs stable disease without clinical changes for at least 3 months, a palpable plaque with a curvature deformity of at least 30 degrees and no more than 90 degrees, intact erectile function, and a maximum of one treatment course with 8 injections total. Both indications require the member to be 18 years of age or older. Cosmetic use is not covered, and all other indications are considered experimental, investigational, or unproven.
Aetna considers the diagnosis and treatment of erectile dysfunction medically necessary under the criteria in its policy, including self-administered injectable medications, the external penile vacuum pump as a physician-prescribed durable medical equipment alternative to other therapies, and implantable penile prostheses when the documented criteria are met. Surgical correction of Peyronie's disease, such as plaque excisions, venous graft patching, tunica plication or the Nesbit tuck, is medically necessary for members who have the condition for 12 or more months with significant morbidity and have failed conservative medical treatment. Many other treatments, including extracorporeal shock wave therapy and testosterone injection for Peyronie's disease and stem cell therapy for erectile dysfunction, are considered experimental, investigational, or unproven.
Aetna considers Xiaflex (collagenase clostridium histolyticum) medically necessary for commercial medical plans when the criteria for Dupuytren's contracture or Peyronie's disease are met. For Dupuytren's contracture, initial approval requires a palpable cord in a metacarpophalangeal or proximal interphalangeal joint, a contracture of at least 20 degrees, a positive tabletop test, age 18 or older, and up to 3 injections per cord 4 weeks apart. For Peyronie's disease, initial approval requires stable disease for at least 3 months, a palpable plaque with a curvature deformity of at least 30 degrees and no more than 90 degrees, intact erectile function, age 18 or older, and a maximum of one treatment course with 8 injections total; cosmetic use is not covered, and ultrasound guidance for Xiaflex injection and hand therapy after collagenase treatment for Dupuytren's contracture are considered experimental, investigational or unproven.
The State and School Employees' Health Insurance Plan covers Xiaflex (collagenase clostridium histolyticum) as medically necessary for adults 18 years of age or older with Dupuytren's contracture or Peyronie's disease when the criteria are met. The 09/01/2025 policy update added criteria for Dupuytren's contracture: the palpable cord must have a contracture of at least 20 degrees, and the individual must not have received surgical treatment such as fasciectomy or fasciotomy on the selected primary joint within the last 90 days. The use of samples will not be considered current or stable therapy to satisfy Medical Policy requirements.
This is a reissue with no substantive changes to Independence Blue Cross Medicare Advantage policy MA08.128 covering collagenase clostridium histolyticum (Xiaflex for Dupuytren's contracture and Peyronie's disease; Qwo for buttocks cellulite). The policy maintains existing coverage criteria, REMS requirements, and cosmetic service exclusions. No billing workflow changes are required.
This is a routine annual policy reissue with no substantive changes to Independence Blue Cross Commercial coverage for collagenase clostridium histolyticum (Xiaflex for Dupuytren's contracture and Peyronie's disease; Qwo for cellulite). Coverage criteria, exclusions, REMS requirements, and billing codes remain unchanged from the original 11/30/2020 effective date.
This is a reissue with no substantive changes to Independence Blue Cross Medicare Advantage policy MA08.128. The policy continues to cover Xiaflex for Dupuytren's contracture and Peyronie's disease under specific clinical criteria, excludes Qwo for buttocks cellulite as cosmetic, and maintains REMS program requirements for Xiaflex prescribers. No billing workflow changes are required.
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