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Sanofi is committed to ensuring all patients with acquired/immune-mediated thrombotic thrombocytopenic purpura (aTTP/iTTP) have access to treatment with CABLIVI. The information below will help guide you in obtaining coverage for your patients.
*This information is subject to change, and providers should consult relevant references for the description of each code to determine its appropriateness. Use of the information below does not guarantee that the payer will provide coverage for CABLIVI and is not intended to be a substitute for, or an influence on, the independent medical judgment of the prescriber.
Coverage
The codes discussed below are provided for informational purposes only, are subject to change, and should not be construed as legal advice. The codes listed herein may not apply to all patients or to all health plans. Conversely, additional codes not listed may apply to some patients.
For patients covered by Medicare, drug costs for doses administered in the hospital are typically included in the MS-DRG payment and are covered under Medicare Part A. After inpatient discharge, most patients will self-administer CABLIVI at home; these drug costs are expected to be covered under the Medicare Part D (pharmacy) benefit.
The 3 MS-DRGs that represent the greatest number of potential patients who may be eligible for treatment involving CABLIVI are shown in the table below.
Potential MS-DRGs1 | |
| 545 | Connective Tissue Disorders With MCC |
| 546 | Connective Tissue Disorders With CC |
| 547 | Connective Tissue Disorders Without CC/MCC |
This may not be reflective of all MS-DRG codes that may be used for CABLIVI. The DRG code is determined by the payer based on the primary diagnosis.
Other reimbursement considerations
The specifics of coverage may vary by payer. Please refer to the individual patient’s plan to determine any applicable coverage requirements.
Diagnosis and procedure codes
There is no specific ICD-10-CM code for aTTP/iTTP. Providers should always review payer-specific materials and use their own clinical judgment when submitting claims for use of CABLIVI.
ICD-10-CM Code2 | |
| M31.10 | Thrombotic microangiopathy†, unspecified |
| M31.19 |
Other thrombotic microangiopathy† Thrombotic thrombocytopenic purpura |
ICD-10-PCS Code3 | |
| XW013W5 –or– 3E013GC |
Introduction of Caplacizumab Into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 5 Introduction of Other Therapeutic Substance into Subcutaneous Tissue, Percutaneous Approach |
| XW033W5 –or– 3E033GC |
Introduction of Caplacizumab Into Peripheral Vein, Percutaneous Approach, New Technology Group 5 Introduction of Other Therapeutic Substance into Peripheral Vein, Percutaneous Approach |
| XW043W5 –or– 3E043GC |
Introduction of Caplacizumab Into Central Vein, Percutaneous Approach, New Technology Group 5 Introduction of Other Therapeutic Substance into Central Vein, Percutaneous Approach |
†Thrombotic microangiopathy has the inclusion note of thrombotic thrombocytopenic purpura, which would describe aTTP/iTTP.
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CC=complication or comorbidity; DRG=diagnosis related group; ICD-10-CM=International Classification of Diseases, Tenth Revision, Clinical Modification; ICD-10-PCS=International Classification of Diseases, Tenth Revision, Procedure Coding System; MCC=major complication or comorbidity; MS-DRG=Medicare Severity Diagnosis Related Group.
INDICATIONS
References: 1. Centers for Medicare & Medicaid Services. ICD-10-CM/PCS MS-DRG v37.0 Definitions Manual. Updated September 12, 2019. Accessed April 14, 2023. https://www.cms.gov/icd10m/version37-fullcode-cms/fullcode_cms/P0213.html 2. Centers for Medicare & Medicaid Services. 2025 ICD-10-CM. Updated effective April 1, 2025. Accessed March 12, 2025. https://www.cms.gov/medicare/coding-billing/icd-10-codes/2025-code-tables-tabular-and-index.zip 3. Centers for Medicare & Medicaid Services. 2023 ICD-10-PCS. Accessed April 12, 2023. https://www.cms.gov/files/zip/2023-icd-10-pcs-code-tables-and-index.zip
