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08.01.71, Collagenase clostridium histolyticum (Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)

Independence Blue Cross·Pharmacy, Plastic Surgery, Urology +1 more·Pharmacy
Effective date
Not stated
We identified it
Jul 9, 2026
Days to comply
—

Summary

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.

Action Required

Action needed
No action required. This is a reissue with no changes to policy content, coverage criteria, or billing procedures. Billing team should retain current workflows for Xiaflex (J0775) claims for Dupuytren's contracture and Peyronie's disease, and continue denying Qwo (J0775) claims as cosmetic. Verify that providers remain aware of REMS certification requirements for Xiaflex Peyronie's disease treatment.

Affected Billing Codes

J0775
M72.0
N48.6

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