Medicare AdvantageAdministrativeLow impact
MA08.128, Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)
Independence Blue Cross·NJ · Pharmacy, Urology, Plastic Surgery·Pharmacy
We identified it
Jul 9, 2026
Summary
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.
Action Required
No immediate action required. This is an annual reissue with no coverage changes. Billing and clinical staff should ensure they are familiar with existing requirements: (1) Xiaflex for Dupuytren's contracture requires contracture ≥20 degrees, palpable cord, and positive tabletop test; (2) Xiaflex for Peyronie's disease requires palpable plaque, ≥30 degree curvature, and pain/sexual dysfunction; (3) Qwo for buttocks cellulite is NOT covered as a cosmetic service; (4) Prescribers must be REMS-certified for Xiaflex Peyronie's disease use. Continue applying existing prior authorization and medical necessity documentation standards. No system updates needed.