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MA08.100e, patisiran (Onpattro®) and vutrisiran (Amvuttra®)
Effective date
Aug 18, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage policy MA08.100e was updated on 08/18/2025 to add coverage criteria for vutrisiran (Amvuttra) for treatment of Wild-Type or Hereditary Transthyretin Amyloidosis with Cardiomyopathy (ATTR-CM) in adults. ICD-10 diagnosis codes were removed from the policy as informational only; providers must report the most appropriate diagnosis code supporting medical necessity. The policy continues to cover both patisiran (Onpattro) and vutrisiran (Amvuttra) for hATTR amyloidosis with polyneuropathy.
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What to do
Action · 6 steps
01By 08/18/2025: Billing team must ensure claims processing systems recognize both HCPCS codes J0222 (patisiran) and J0225 (vutrisiran) for Medicare Advantage members.
02Update prior authorization workflows to distinguish between two covered indications: (1) hATTR amyloidosis with polyneuropathy (both drugs eligible) and (2) Wild-Type or Hereditary ATTR-CM with cardiomyopathy (vutrisiran only).
03For all claims, ensure providers document diagnosis codes supporting one of the two qualifying conditions per policy criteria.
04Remove any outdated ICD-10 code lists from internal billing references; educate providers that they must report the most appropriate diagnosis code based on clinical documentation.
05Verify that prior authorization requests for vutrisiran now include ATTR-CM as a covered indication alongside existing hATTR-polyneuropathy approvals.
06No claims will process without documented medical necessity meeting the specific criteria outlined in the policy.
Codes mentioned
J0222J0225
Original notice
MA08.100e, patisiran (Onpattro®) and vutrisiran (Amvuttra®)
medpolicy.ibx.com · Always check the source before changing claims.