Rethymic (allogenic processed thymus tissue - agdc) - Medicare Advantage

This policy covers Rethymic (allogeneic processed thymus tissue‑agdc), an FDA‑approved surgically implanted thymus tissue product for immune reconstitution in congenital athymia in pediatric patients (≤17 years), typically given as a single lifetime dose. Coverage is limited to confirmed congenital athymia (e.g., very low naïve T‑cell counts by flow cytometry and genetic testing, often identified via newborn SCID screening), requires medical director review, and does not apply to other or unconfirmed diagnoses and is subject to Medicare medical‑necessity and plan‑specific rules.

"Implicit age limitation: applies to pediatric individuals (text specifically refers to "a pediatric individual diagnosed with congenital athymia") — adult congenital athymia not described/covered i..."

Sign up to see full coverage criteria, indications, and limitations.