CurrentCignaPolicy N/A

Romvimza (vimseltinib) for tenosynovial giant cell tumor (TGCT)/PVNS — Coverage Criteria

Defines Cigna coverage and prior authorization guidance for Romvimza (vimseltinib capsules) for treatment of tenosynovial giant cell tumor/PVNS in adults; applies to health benefit plans administered by Cigna companies.

Policy Summary

PayerCigna

PolicyRomvimza (vimseltinib) for TGCT/PVNS — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateFeb 11, 2026

Key ActionObtain prior authorization for prescription benefit coverage of Romvimza; approvals are provided for the duration noted in the policy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1 yearinitial approval duration

≥18minimum patient age

FDA-onlycoverage restriction

NCCN Preferredguideline recommendation

Not covered other usesexclusion stance

Coverage Criteria for Romvimza (vimseltinib)

FDA-Approved Indication

Covered when ALL of the following are met for the FDA-approved indication:

Romvimza FDA-approved indication criteria

Indication
- A: Patient is ≥ 18 years of age.
- B: The tumor is not amenable to improvement with surgery (surgical resection may worsen function or cause severe morbidity).

Romvimza™ (vimseltinib) is considered not medically necessary for any other use(s) beyond those explicitly stated in this policy.

Any use of Romvimza other than the specified FDA‑approved indication for tenosynovial giant cell tumor (TGCT)/pigmented villonodular synovitis (PVNS) is not medically necessary and is excluded from coverage under this policy.

Policy Summary

PayerCigna

PolicyRomvimza (vimseltinib) for TGCT/PVNS — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateFeb 11, 2026

Key ActionObtain prior authorization for prescription benefit coverage of Romvimza; approvals are provided for the duration noted in the policy.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider Actions, Authorization, and Billing

Prior Authorization

Prior Authorization Recommended

Prior authorization recommended — Prior authorization is recommended for prescription benefit coverage; approvals are provided for the duration noted in the policy.

Romvimza (vimseltinib) — prior authorization applies for prescription benefit coverage; approvals issued for the duration indicated in the policy.

Step Therapy

Step therapy — No step therapy requirements specified in this policy.

Documentation Required

Documentation and Coding Requirements

Documentation and coding requirements — Coverage determinations require consideration of benefit plan terms, laws/regulations, and relevant collateral materials. When billing, providers must use the most appropriate codes as of the date of submission. Claims submitted for services not accompanied by covered diagnosis or procedure codes under the applicable coverage policy will be denied as not covered.

Verify member's applicable benefit plan document and any controlling laws/regulations.
Use appropriate diagnosis and procedure codes effective on the date of service.

Denial Risk

Billing Code/Diagnosis Mismatch

Billing code/diagnosis mismatch — Claims without covered diagnosis or procedure codes under the applicable coverage policy will be subject to denial or follow‑up.

Claims for services billed for conditions or diagnoses not covered under this policy will be denied as not covered.

Regimen	Indication	Guideline status
Romvimza (vimseltinib)	Tenosynovial giant cell tumor (TGCT) / Pigmented villonodular synovitis (PVNS)	NCCN preferred regimen (category 1)

Definitions

Tenosynovial giant cell tumor (TGCT) / PVNS — definition and indication context

TermTenosynovial giant cell tumor (TGCT) — also known as pigmented villonodular synovitis (PVNS)

DefinitionA locally aggressive neoplasm of the synovium for which Romvimza is indicated when the disease is symptomatic and surgical resection may cause worsening functional limitation or severe morbidity in adults.

Affected populationAdults (patients ≥ 18 years) with symptomatic disease for whom surgery may be morbid or worsen function.

Clinical contextIndication is limited to cases where tumor-related symptoms exist and surgical resection is likely to result in significant functional impairment or severe morbidity.

Related termPigmented villonodular synovitis (PVNS) — alternative name used interchangeably with TGCT.

OpenPayer

Romvimza (vimseltinib) for tenosynovial giant cell tumor (TGCT)/PVNS — Coverage Criteria

Coverage Criteria for Romvimza (vimseltinib)

Provider Actions, Authorization, and Billing

Covered Regimens and Preferred Use

Definitions

Background