CommercialPrior AuthMedium impact
Xiaflex (collagenase clostridium histolyticum)
Blue Cross & Blue Shield of Mississippi·MS · Orthopedics, Urology, Plastic Surgery·Medical Policy
We identified it
Jun 20, 2026
Summary
This policy establishes prior authorization requirements for Xiaflex (collagenase clostridium histolyticum) injections used to treat Dupuytren's contracture and Peyronie's disease. The policy outlines specific medical necessity criteria including age requirements, degree of contracture/curvature, functional impairment documentation, and provider certification requirements through the Xiaflex REMS Program.
Action Required
Immediately: Billing team must update system to require prior authorization for all Xiaflex (J0775) and related injection procedure (20527) claims. Providers must verify patient meets specific criteria: age 18+, documented contracture degrees, functional impairment, no recent surgery, and provider REMS certification for Peyronie's disease cases. Update encounter forms to include documentation requirements. Claims without prior authorization will be denied.