Zevaskyn (prademagene zamikeracel) - Medicare Advantage

This policy covers Zevaskyn (prademagene zamikeracel), an autologous genetically modified cell-sheet therapy (up to twelve 41.25 cm² sheets in a single-dose course) surgically applied to wounds to rebuild skin in individuals with recessive dystrophic epidermolysis bullosa (RDEB) caused by COL7A1 mutations, with related services (e.g., skin harvest CPT 15040) billed under applicable codes (e.g., J3590). Coverage is limited to patients aged 6–65 with clinical or genetic confirmation of RDEB/COL7A1 mutation, requires prior review/authorization (including referral to the Corporate Transplant Department and medical director review), and is restricted to autologous, single-dose use; use outside these criteria is not covered by this policy.

"Documentation confirming the patient has a COL7A1 mutation (genetic testing results)."

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