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State and School Employees' Health Insurance Plan - Treatment of Epidermolysis Bullosa

Blue Cross & Blue Shield of Mississippi·MS · Dermatology, Wound Care·Medical Policy
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

This policy establishes coverage criteria for Vyjuvek gene therapy for dystrophic epidermolysis bullosa treatment under the State and School Employees' Health Insurance Plan. The policy requires extensive documentation including genetic testing confirmation and specialist consultation, with 6-month approval periods.

Action Required

Action needed
Billing team should review criteria for Vyjuvek (beremagene geperpavec-svdt) coverage and ensure proper documentation is obtained before billing. Verify genetic testing confirmation and specialist consultation are documented when submitting claims with codes J3401 or unclassified drug codes for this therapy.

Affected Billing Codes

C9399
J3401
J3490
J3590
Q81.2

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