Asparaginase Erwinia Chrysanthemi (Recombinant)-rywn (Rylaze) (CPB 0864, reviewed 2025-12-02)

By December 2, 2025: Billing team must implement the following changes: (1) Update billing system to recognize J9021 (Rylaze) as a covered HCPCS code for commercial Aetna plans when billed with appropriate ICD-10 diagnosis codes (C83.50-C83.59, C86.01-C86.61, C91.00-C91.02, C94.80-C94.82); (2) Establish prior authorization workflow requiring documentation that patient has developed hypersensitivity to E. coli-derived asparaginase (pegaspargase/J9266) and that Rylaze will be used with multi-agent chemotherapy; (3) Update claim scrubbing rules to deny J9021 claims for non-covered indications (brain tumors, lymphomas other than specified types, other malignancies); (4) Alert oncology providers to include in authorization requests: confirmation of prior E. coli asparaginase hypersensitivity, multi-agent chemotherapy plan documentation, and proper ICD-10 diagnosis coding; (5) Note that therapeutic drug monitoring (asparaginase activity levels) is not covered and should not be billed. Failure to obtain proper prior authorization or use correct codes will result in claim denials.