Medicare AdvantageAdministrativeLow impact
MA08.171, ADAMTS13, recombinant-krhn (Adzynma)
Independence Blue Cross·Hematology, Pediatrics, Internal Medicine·Medical Policy
We identified it
Jun 19, 2026
Summary
This is a reissue of Independence Blue Cross Medicare Advantage policy MA08.171 with no substantive changes to coverage criteria. The policy confirms coverage for Adzynma (ADAMTS13, recombinant-krhn) for prophylactic and on-demand treatment of congenital thrombotic thrombocytopenic purpura (cTTP) in adult and pediatric patients meeting specific diagnostic and dosing requirements. No billing workflow changes are required.
Action Required
No immediate action required. This is a reissue with no changes to the existing policy effective 07/15/2024. Billing team should verify that claims for HCPCS code J7171 include proper documentation of cTTP diagnosis (D69.42), confirmed biallelic ADAMTS13 mutations, ADAMTS13 activity <10%, and hematologist prescription/consultation. Ensure dosing reflects either prophylactic (40 IU/kg every other week or weekly) or on-demand acute event treatment protocols. No system updates or prior authorization workflow modifications are needed at this time.