CommercialPrior AuthHigh impact
Eladocagene Exuparvovec-tneq (Kebilidi) (CPB 1073, reviewed 2026-03-27)
Aetna·Neurology, Neurosurgery, Genetics +2 more·Medical Policy
Effective date
Mar 27, 2026
We identified it
Aug 13, 2026
Summary
Aetna has established a new Clinical Policy Bulletin (CPB 1073) for Kebilidi (eladocagene exuparvovec-tneq), a gene therapy for aromatic L-amino acid decarboxylase (AADC) deficiency in pediatric patients aged 16 months to 10 years. This policy requires mandatory precertification, restricts treatment to Aetna Institutes GCIT Network facilities, and establishes strict clinical criteria including specific CSF metabolite profiles, genetic confirmation, and neurological assessments. Billing teams must implement precertification workflows immediately and ensure all related diagnostic testing and surgical codes are properly coordinated.
Action Required
IMMEDIATELY: Billing and precertification teams must (1) Establish precertification protocol for all Kebilidi cases by calling (866) 752-7021 or faxing (888) 267-3277 before any treatment authorization; (2) Update billing system to flag CPT codes 62270, 61781, 61782, 70551-70553, 82542, 86325, 88108, 96521, and 96522 with ICD-10 E70.81 as requiring Aetna precertification; (3) Create provider education materials documenting the seven clinical approval criteria (age 16 months-10 years, specific CSF neurotransmitter levels, decreased AADC plasma activity, biallelic DDC gene variants, failure of standard therapy, non-ambulatory status, adequate skull maturity); (4) Verify treatment is performed only at Aetna Institutes GCIT Designated Network facilities—claims from non-network facilities will be denied; (5) Ensure all precertification requests include Statement of Medical Necessity (SMN) forms from Specialty Pharmacy Precertification; (6) Flag any members with anti-AAV2 antibody titers >1:1200, pyridoxine/BH4 deficiency, or active infections as ineligible and deny precertification. Failure to obtain precertification will result in automatic claim denial.