Remestemcel-L-rknd (Ryoncil) (CPB 1077, reviewed 2026-05-27)

By 2026-05-27: Billing and prior authorization teams must implement the following: (1) Establish precertification process for all Ryoncil infusions by updating authorization requirements in billing software and prior auth workflows to require calls to (866) 752-7021 or faxes to (888) 267-3277 before patient treatment; (2) Configure system edits to verify patient eligibility as pediatric (2 months or older) and confirm steroid-refractory status (progression within 3 days or no improvement within 7 days of methylprednisolone 2 mg/kg/day or equivalent); (3) Train billing staff on the treatment response assessment timeline (Day 28 ± 2) and subsequent authorization rules (maximum 8 initial infusions, up to 4 additional for partial/mixed response, or 8 for recurrence); (4) Update encounter forms and clinical documentation templates to capture steroid-refractory criteria, prior steroid dosing, and treatment response status; (5) Ensure ICD-10 diagnosis code D89.810 (acute graft-versus-host disease, steroid-refractory) is used for all claims; (6) Configure billing system to link infusion codes (96365, 96366) with supportive medications (J1020, J1030, J1040, J2920, J2930, J7506, J7509, J7510, J8540) for bundling assessment. Communicate policy details to all hematology and transplant providers, oncology centers, and hospital infusion centers. Failure to obtain precertification will result in claim denials. Claims without steroid-refractory documentation will be denied.