Does J7171 require prior authorization?

Yes, J7171 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J7171?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`J7171`, Injection, adamts13, recombinant-krhn, 10 iu

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Patient age documentation to confirm adult status (≥ 18 years)
Reference to the member specific benefit plan document is required when deciding coverage.
Check applicable federal or state mandates prior to applying this policy.
Confirmation of ADAMTS13 mutation by molecular genetic testing.
Documentation that Adzynma is being prescribed for routine prophylactic treatment to prevent TTP events.
For continuation requests: documentation that the patient has previously received routine prophylactic treatment with Adzynma.

Key Coverage Criteria

Adzynma (ADAMTS13, recombinant-krhn) is proven and medically necessary for prophylactic treatment of congenital thrombotic thrombocytopenic purpura (cTTP) in patients who meet all of the following criteria:
For initial therapy: Diagnosis of congenital thrombotic thrombocytopenic purpura (cTTP) where Adzynma is being prescribed for routine prophylactic treatment to prevent thrombotic thrombocytopenic purpura (TTP) events, with ADAMTS13 mutation confirmed by molecular genetic testing.
For continuation of therapy: Patient previously received routine prophylactic treatment with Adzynma and Adzynma is being continued for ongoing routine prophylactic treatment to prevent TTP events, with documentation of positive clinical response to Adzynma therapy.
Adzynma (ADAMTS13, recombinant-krhn) is proven and medically necessary for on demand treatment of an acute thrombotic thrombocytopenic purpura (TTP) event in patients with congenital thrombotic thrombocytopenic purpura (cTTP) who meet all of the following criteria:
Diagnosis of congenital thrombotic thrombocytopenic purpura (cTTP)
ADAMTS13 mutation is confirmed by molecular genetic testing

20 Active Policies

ARKBLUE-ADAMTS13-RECOMBINANT-KRHN-E-G-ADZYNMA-9EFEFA1B8E, ADAMTS13, recombinant-krhn (e.g., Adzynma)

BCBSLA-00887-B94F61A658, 00887 ADAMTS13, recombinant-krhn (Adzynma)

BCBSM-2181822-7747BEF3D1, ADZYNMA (ADAMTS13, RECOMBINANT-KRHN)

POINT32HEALTH-MDMNG-12221, Adzynma (ADAMTS13, recombinantkrhn)

MULTI

POINT32HEALTH-MDMNG-12241, Adzynma (ADAMTS13, recombinantkrhn)

MULTI

HEALTHPARTNERS-CC-ENTRY-270360, ADAMTS13, recombinant-krhn (Adzynma)

MULTI

POINT32HEALTH-MDMNG-12231, Adzynma (ADAMTS13, recombinantkrhn)

MULTI

MODA-ADZYNMA-0CC9C11150, Adzynma (ADAMTS13, recombinant-krhn)

HEALTHNET_OR-HNOR-ADAMTS13-RECOMBINANT-KRHN-ADZYNMA-CP-PHAR-635-0071F3676D, ADAMTS13, Recombinant-krhn) (Adzynma); CP.PHAR.635

IBX-COMMERCIAL-08-02-21-AAD49849EE, ADAMTS13, recombinant-krhn (Adzynma)

IBX-MEDICARE-ADVANTAGE-MA08-171-8AD8C7B08C, ADAMTS13, recombinant-krhn (Adzynma)

SUREST-POL-SUREST-adzynma, Adzynma (ADAMTS13, Recombinant-Krhn)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-171-79002DDF48, ADAMTS13, recombinant-krhn (Adzynma)

BCBSTN-df23ed5e28, ADAMTS13, recombinant-krhn (Adzynma)

EVICORE-MEDICAL_DRUG-10DB9DE908E9, Adzynma (ADAMTS13 recombinant-krhn)

UHC-COMM-MD-ADZYNMA-ADAMTS13-RECOMBINANT-KRHN-COMMUN-AA9B5FBAE3, Adzynma (ADAMTS13, Recombinant-Krhn) – Community Plan Medical Benefit Drug Policy

UHC-EXCH-MD-ADZYNMA-ADAMTS13-RECOMBINANT-KRHN-COMMER-BE51B9CC42, Adzynma (ADAMTS13, Recombinant-Krhn) – Commercial and Individual Exchange Medical Benefit Drug Policy

UHC-POL-adzynma, Adzynma (ADAMTS13, Recombinant-Krhn)

UHC-POL-provider-administered-drugs-soc, Provider Administered Drugs – Site of Care

UMR-POL-UMR-adzynma, Adzynma (ADAMTS13, Recombinant-Krhn)

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Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about J7171 Sign up free

J7171, Injection, adamts13, recombinant-krhn, 10 iu

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Patient age documentation to confirm adult status (≥ 18 years)
Reference to the member specific benefit plan document is required when deciding coverage.
Check applicable federal or state mandates prior to applying this policy.
Confirmation of ADAMTS13 mutation by molecular genetic testing.
Documentation that Adzynma is being prescribed for routine prophylactic treatment to prevent TTP events.
For continuation requests: documentation that the patient has previously received routine prophylactic treatment with Adzynma.

Key Coverage Criteria

Adzynma (ADAMTS13, recombinant-krhn) is proven and medically necessary for prophylactic treatment of congenital thrombotic thrombocytopenic purpura (cTTP) in patients who meet all of the following criteria:
For initial therapy: Diagnosis of congenital thrombotic thrombocytopenic purpura (cTTP) where Adzynma is being prescribed for routine prophylactic treatment to prevent thrombotic thrombocytopenic purpura (TTP) events, with ADAMTS13 mutation confirmed by molecular genetic testing.
For continuation of therapy: Patient previously received routine prophylactic treatment with Adzynma and Adzynma is being continued for ongoing routine prophylactic treatment to prevent TTP events, with documentation of positive clinical response to Adzynma therapy.
Adzynma (ADAMTS13, recombinant-krhn) is proven and medically necessary for on demand treatment of an acute thrombotic thrombocytopenic purpura (TTP) event in patients with congenital thrombotic thrombocytopenic purpura (cTTP) who meet all of the following criteria:
Diagnosis of congenital thrombotic thrombocytopenic purpura (cTTP)
ADAMTS13 mutation is confirmed by molecular genetic testing

20 Active Policies

ARKBLUE-ADAMTS13-RECOMBINANT-KRHN-E-G-ADZYNMA-9EFEFA1B8E, ADAMTS13, recombinant-krhn (e.g., Adzynma)

BCBSLA-00887-B94F61A658, 00887 ADAMTS13, recombinant-krhn (Adzynma)

BCBSM-2181822-7747BEF3D1, ADZYNMA (ADAMTS13, RECOMBINANT-KRHN)

POINT32HEALTH-MDMNG-12221, Adzynma (ADAMTS13, recombinantkrhn)

MULTI

POINT32HEALTH-MDMNG-12241, Adzynma (ADAMTS13, recombinantkrhn)

MULTI

HEALTHPARTNERS-CC-ENTRY-270360, ADAMTS13, recombinant-krhn (Adzynma)

MULTI

POINT32HEALTH-MDMNG-12231, Adzynma (ADAMTS13, recombinantkrhn)

MULTI

MODA-ADZYNMA-0CC9C11150, Adzynma (ADAMTS13, recombinant-krhn)

HEALTHNET_OR-HNOR-ADAMTS13-RECOMBINANT-KRHN-ADZYNMA-CP-PHAR-635-0071F3676D, ADAMTS13, Recombinant-krhn) (Adzynma); CP.PHAR.635

IBX-COMMERCIAL-08-02-21-AAD49849EE, ADAMTS13, recombinant-krhn (Adzynma)

IBX-MEDICARE-ADVANTAGE-MA08-171-8AD8C7B08C, ADAMTS13, recombinant-krhn (Adzynma)

SUREST-POL-SUREST-adzynma, Adzynma (ADAMTS13, Recombinant-Krhn)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-171-79002DDF48, ADAMTS13, recombinant-krhn (Adzynma)

BCBSTN-df23ed5e28, ADAMTS13, recombinant-krhn (Adzynma)

EVICORE-MEDICAL_DRUG-10DB9DE908E9, Adzynma (ADAMTS13 recombinant-krhn)

UHC-COMM-MD-ADZYNMA-ADAMTS13-RECOMBINANT-KRHN-COMMUN-AA9B5FBAE3, Adzynma (ADAMTS13, Recombinant-Krhn) – Community Plan Medical Benefit Drug Policy

UHC-EXCH-MD-ADZYNMA-ADAMTS13-RECOMBINANT-KRHN-COMMER-BE51B9CC42, Adzynma (ADAMTS13, Recombinant-Krhn) – Commercial and Individual Exchange Medical Benefit Drug Policy

UHC-POL-adzynma, Adzynma (ADAMTS13, Recombinant-Krhn)

UHC-POL-provider-administered-drugs-soc, Provider Administered Drugs – Site of Care

UMR-POL-UMR-adzynma, Adzynma (ADAMTS13, Recombinant-Krhn)

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about J7171 Sign up free

`J7171`, Injection, adamts13, recombinant-krhn, 10 iu

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J7171`, Injection, adamts13, recombinant-krhn, 10 iu

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J7171, Injection, adamts13, recombinant-krhn, 10 iu

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J7171, Injection, adamts13, recombinant-krhn, 10 iu

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J7171`, Injection, adamts13, recombinant-krhn, 10 iu

`J7171`, Injection, adamts13, recombinant-krhn, 10 iu