34 commercial payer policies list J0775. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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34 policies from 20 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
| Policy | Effective | Status of J0775 |
|---|---|---|
| Collagenase Clostridium Histolyticum (Xiaflex)Effective 01/01/2019 - 06/30/2019 | Jan 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Collagenase clostridium histolyticum (Xiaflex)Effective 04/01/2022 - 03/31/2023 | Apr 1, 2022 | Prior auth requiredInferred from policy title |
| Collagenase clostridium histolyticum (Xiaflex)Effective 04/01/2023 - 02/29/2024 | Apr 1, 2023 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Collagenase clostridium histolyticum (Xiaflex)Effective 05/01/2021 - 03/31/2022 | May 1, 2021 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Collagenase clostridium histolyticum (Xiaflex)Effective 06/01/2020 - 04/30/2021 | Jun 1, 2020 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Collagenase clostridium histolyticum (Xiaflex)Effective 07/01/2019 - 05/31/2020 | Jul 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Xiaflex (collagenase clostridium histolyticum) | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Xiaflex (collagenase clostridium histolyticum)Effective 03/01/2024 - 02/28/2025 | Mar 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Xiaflex (collagenase clostridium histolyticum)Effective 03/01/2025 - 03/31/2026 | Mar 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of J0775 |
|---|---|---|
| Xiaflex (Collagenase Clostridium Histolyticum) | Jan 1, 2026 | Covered |
| Xiaflex (Collagenase Clostridium Histolyticum) – Community Plan Medical Benefit Drug Policy | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Xiaflex (Collagenase Clostridium Histolyticum) – Individual Exchange Medical Benefit Drug Policy | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0775 |
|---|---|---|
| Collagenase clostridium histolyticum ( Xiaflex ), collagenase clostridium histolyticum-aaes (Qwo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Collagenase clostridium histolyticum (Xiaflex ), collagenase clostridium histolyticum-aaes (Qwo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0775 |
|---|---|---|
| State and School Employees' Health Insurance Plan - Xiaflex (collagenase clostridium histolyticum) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Xiaflex (collagenase clostridium histolyticum) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0775 |
|---|---|---|
| Collagenase clostridium histolyticum ( Xiaflex ), collagenase clostridium histolyticum-aaes (Qwo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Collagenase clostridium histolyticum (Xiaflex ), collagenase clostridium histolyticum-aaes (Qwo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0775 |
|---|---|---|
| Xiaflex (collagenase clostridium histolyticum) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Xiaflex (collagenase clostridium histolyticum) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0775 |
|---|---|---|
| Cosmetic Surgery and Procedures | Feb 8, 2024 | Covered |
| Policy | Effective | Status of J0775 |
|---|---|---|
| Injectable Clostridial Collagenase for Fibroproliferative Disorders | Nov 15, 2025 | Covered |
| Policy | Effective | Status of J0775 |
|---|---|---|
| Injectable Clostridial Collagenase for Fibroproliferative Disorders | Nov 15, 2025 | Covered |
| Policy | Effective | Status of J0775 |
|---|---|---|
| Injectable Clostridial Collagenase for Fibroproliferative Disorders | Nov 15, 2025 | Covered |
| Policy | Effective | Status of J0775 |
|---|---|---|
| Injectable Clostridial Collagenase for Fibroproliferative Disorders | Nov 15, 2025 | Covered |
| Policy | Effective | Status of J0775 |
|---|---|---|
| XIAFLEX (COLLAGENASE CLOSTRIDIUM HISTOLYTICUM) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0775 |
|---|---|---|
| Collagenase Clostridium Histolyticum (Xiaflex) | Aug 14, 2010 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0775 |
|---|---|---|
| Collagenase Clostridium Histolyticum (Xiaflex); CP.PHAR.82 | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0775 |
|---|---|---|
| Collagenase (Xiaflex) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0775 |
|---|---|---|
| Xiaflex | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0775 |
|---|---|---|
| Xiaflex (Collagenase Clostridium Histolyticum) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0775 |
|---|---|---|
| Xiaflex (collagenase) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0775 |
|---|---|---|
| Xiaflex (Collagenase Clostridium Histolyticum) | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0775 |
|---|---|---|
| Xiaflex (Collagenase Clostridium Histolyticum) | Jan 1, 2026 | Covered |