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Etuvetidigene Autotemcel (Waskyra) (CPB 1097, reviewed 08-2026-04)
Effective date
Not stated in the notice
Identified
Aug 13, 2026
Summary
Aetna's Clinical Policy Bulletin 1097 covers etuvetidigene autotemcel (Waskyra), a one-time gene therapy for Wiskott-Aldrich syndrome, for commercial medical plans. Aetna requires precertification and treats the therapy as medically necessary only when the patient meets the listed diagnosis, transplant candidacy and infection-screening criteria, and treats all other indications as experimental. The source states no effective date, so confirm the current policy before acting.
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What to do
Action · 6 steps
01No effective date is stated in the source, so check Aetna's current policy before changing workflows.
02Billing team and providers: call National Medical Excellence at 877-212-8811 to get precertification before this therapy is scheduled or administered, since the source says it is required.
03Arrange administration at an Aetna GCIT Designated Network unless the member's plan does not require it.
04Providers: confirm the prescriber is an immunologist, hematologist or a physician who treats Wiskott-Aldrich syndrome, and document the diagnosis with D82.0, the pathogenic WAS gene variant, WASP expression or Zhu score of 3 or more, and the absence of a suitable HLA-matched sibling donor.
05Billing team: check the file for the listed exclusions (HIV, hepatitis, active tuberculosis, malignancy, and prior gene therapy) before submitting the precertification request, and for apheresis and transplant-related services, confirm they are billed under the codes in the CPB.
06Other indications are experimental under Aetna's policy.
Codes mentioned
D82.0382053824038241382063820736511881848818588187S2150
Original notice
Etuvetidigene Autotemcel (Waskyra) (CPB 1097, reviewed 08-2026-04)
aetna.com · Always check the source before changing claims.
Related changes
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