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08.01.50e, Patisiran (Onpattro®) and vutrisiran (Amvuttra®)
Act
by Aug 18, 2025
Effective date
Aug 18, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross updated policy 08.01.50e to add coverage criteria for vutrisiran (Amvuttra) for treatment of wild-type or hereditary transthyretin amyloidosis with cardiomyopathy (ATTR-CM) in adults. The policy now covers both patisiran (Onpattro) and vutrisiran for polyneuropathy and cardiomyopathy indications. All ICD-10 codes were removed as informational; billing teams must report appropriate diagnosis codes supporting medical necessity criteria outlined in the policy.
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What to do
by Aug 18, 2025 · 5 steps
01Billing team must update systems and clinical staff on expanded vutrisiran (Amvuttra, J0225) coverage for ATTR-CM.
02Ensure prior authorization processes are in place for both J0222 (patisiran) and J0225 (vutrisiran) claims by verifying all medical necessity criteria are met before submission.
03Update clinical documentation templates and encounter forms to capture required evidence: TTR amyloid deposits or scintigraphy results, echocardiography findings (septal wall thickness >12mm), heart failure history/clinical evidence, NYHA functional class, and cardiologist/amyloidosis specialist involvement.
04Train billing staff and providers that ICD-10 diagnosis codes are no longer listed in policy—report the most appropriate diagnosis code supporting medical necessity per policy criteria.
05Implement pre-billing validation to confirm all five medical necessity criteria are documented before claim submission to prevent denials.
If missed: Failure to obtain proper documentation and authorization will result in claim denials.
Codes mentioned
J0222J0225
Original notice
08.01.50e, Patisiran (Onpattro®) and vutrisiran (Amvuttra®)
medpolicy.ibx.com · Always check the source before changing claims.