CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Treatment of Cardiomyopathy of Wild-Type or Hereditary Transthyretin-Mediated Amyloidosis
Blue Cross & Blue Shield of Mississippi·MS · Cardiology, Neurology, Internal Medicine·Medical Policy
Effective date
Dec 2, 2025
We identified it
Jun 20, 2026
Summary
The State and School Employees' Health Insurance Plan now considers Amvuttra (vutrisiran) injection for treating cardiomyopathy of transthyretin-mediated amyloidosis as NOT medically necessary due to available formulary alternatives. Claims for HCPCS code J0225 and related administration services will be denied.
Action Required
Immediately: Stop billing HCPCS code J0225 (vutrisiran injection) for State and School Employees' Health Insurance Plan members with ATTR-CM diagnosis. Billing team must update system to flag this code as non-covered for this payer. Check formulary for covered alternatives before treatment. Claims submitted will be denied.