CommercialCoverageLow impact
08.01.26e, Enzyme Replacement Therapy for Adenosine Deaminase Severe Combined Immune Deficiency (e.g., elapegademase-lvlr [Revcovi])
Independence Blue Cross·Allergy & Immunology, Pediatrics, Genetics·Medical Policy
Effective date
Jan 2, 2026
We identified it
Jun 19, 2026
Summary
This policy establishes coverage criteria for enzyme replacement therapy (elapegademase-lvlr [Revcovi]) for adenosine deaminase severe combined immune deficiency (ADA-SCID). Billing teams must ensure claims for this rare disease therapy meet documented medical necessity requirements and are billed with the correct HCPCS code. This is a specialized therapy requiring careful claim submission.
Action Required
By January 2, 2026: Billing team must familiarize staff with coverage criteria for elapegademase-lvlr (Revcovi) claims under policy 08.01.26e. Ensure all claims are submitted with HCPCS code J2997 and include documentation of ADA-SCID diagnosis per policy requirements. Contact the payer's medical policy department to confirm any prior authorization requirements before claim submission. This affects a rare patient population; coordinate with providers treating immunodeficiency disorders to ensure proper documentation at point of care.