CMS assigns a procedure code for Abeona's gene therapy, boosting access and reimbursement for RDEB patients.
The Centres for Medicare and Medicaid Services (CMS) has
assigned Abeona Therapeutics a product-specific procedure code ICD-10-PCS for
prademagene zamikeracel (pz-cel), an experimental autologous cell-based gene
therapy for recessive dystrophic epidermolysis bullosa (RDEB). This code, which
will take effect on October 1, 2024, will make it possible to use pz-cel for
efficient inpatient hospital procedure documentation, billing, and analysis.
CMS assigned Medicare reimbursement of pz-cel to Pre-Major Diagnostic Category,
Medicare Severity Diagnosis Related Group 018 (Pre-MDC MS-DRG 018), one of the
highest available inpatient hospital reimbursement levels for cell and gene
therapies, as part of the Inpatient Prospective Payment System (IPPS) Final
Rule for fiscal year 2025.
Madhav Vasanthavada, Chief Commercial Officer of Abeona,
expressed his happiness with the CMS decision, saying that it gives confidence
in guaranteeing good access and reimbursement for all RDEB patients and
acknowledges the groundbreaking nature of gene therapy technology.
