Medicare AdvantageAdministrativeLow impact
MA08.128, Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)
Independence Blue Cross·NJ · Plastic Surgery, General Surgery, Urology +2 more·Pharmacy
We identified it
Jun 19, 2026
Summary
This is a reissue with no substantive changes to Independence Blue Cross Medicare Advantage policy MA08.128. The policy continues to cover Xiaflex for Dupuytren's contracture and Peyronie's disease under specific clinical criteria, excludes Qwo for buttocks cellulite as cosmetic, and maintains REMS program requirements for Xiaflex prescribers. No billing workflow changes are required.
Action Required
No immediate action required. This is an informational reissue confirming existing coverage policies. Billing team should verify current system settings align with existing criteria: Xiaflex (J0775) requires documentation of palpable cord and flexion contracture ≥20° for Dupuytren's or palpable plaque with ≥30° curvature for Peyronie's. Qwo (J0775) claims for buttocks cellulite will be denied as cosmetic exclusion. Ensure providers administering Xiaflex for Peyronie's disease maintain REMS certification. No system updates needed unless previous configurations deviated from this policy.