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Elivaldogene Autotemcel (Skysona) (CPB 1017, reviewed 2026-04-08)

Aetna·Genetics, Hematology, Oncology +2 more·Medical Policy
Effective date
Apr 8, 2026
We identified it
Aug 13, 2026
Days to comply

Summary

Aetna has issued a new Clinical Policy Bulletin (CPB 1017, effective 2026-04-08) establishing coverage criteria for Skysona (elivaldogene autotemcel), a gene therapy for early active cerebral adrenoleukodystrophy (CALD) in boys ages 4-17. This is a specialized therapy requiring precertification, administration at designated Aetna Institutes GCIT Network facilities, and compliance with strict clinical and laboratory eligibility criteria. Billing teams must implement precertification requirements and ensure only qualifying patients are billed for this high-cost therapy.

Action Required

Action needed
By 2026-04-08, the billing team must: (1) Implement precertification workflow requiring all Skysona claims (J3387) to be submitted to National Medical Excellence (NME) at 877-212-8811 before treatment authorization; (2) Update billing system to flag J3387 claims and verify patient meets ALL clinical criteria (age 4-17 male, confirmed ABCD1 pathogenic variant, elevated VLCFA, Loes score 0.5-9, NFS ≤1, HLA-matched donor unavailable, no prior gene therapy/allo-HSCT, normal hematologic/hepatic/renal/cardiac function, negative serology for HIV/HBV/HCV/HTLV); (3) Ensure claims are billed ONLY when treatment occurs at Aetna Institutes GCIT Designated Network facilities; (4) Add ICD-10 codes E71.520, E71.521, E71.528, E71.529 to encounter forms for CALD diagnosis verification; (5) Update provider billing guidelines to require physician specialization in adrenoleukodystrophy treatment; (6) Configure system to deny claims for patients with exclusions (CALD secondary to head trauma, full ABCD1 deletions, or adrenal insufficiency treatment). Failure to obtain precertification will result in claim denials and recoupment.

Affected Billing Codes

J3387
38205
38240
38241
81370
81371
81372
81373
81374
81375
81376
81377
81378
81379
81380
81381
81382
81383
82247
82565
82575
82726
84450
84460
85004
85018
85025
85027
85048
85049
86367
86687
86688
86689
86701
86702
86703
86704
86705
86706
86803
86804
87340
87341
87389
87516
87520
87521
87534
87535
87537
87538
88720
96365
96366
96367
96368
J1212
E71.520
E71.521
E71.528
E71.529