CMS Grants Key Procedure Code for Abeona’s Gene Therapy for RDEB

 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.