Medical Policy: Crysvita (burosumab-twza) subcutaneous injection
Defines medical necessity criteria, dosing limits, length of authorization, coding, exclusions, and renewal for Crysvita (burosumab-twza) for X-linked hypophosphatemia (XLH) and tumor-induced osteomalacia (TIO) under EmblemHealth/ConnectiCare.
Annual Review 3/26/2025: Updated term 'mutation' to 'pathogenic variant'; clarified Epidermal Nevus Syndrome to include Cutaneous Skeletal Hypophosphatemia Syndrome; updated billable units and quantity limits.
Annual Review 5/6/2024: Added ICD-10 code E83.39 and removed eviCore management statement.
9/6/2023: Updated NDCs—removed prior NDCs and added new 42747-series NDCs.
4/4/2023: Transfer from CCUM Template to Medical CoBranded Template; retired prior policy MG.MM.PH.116.
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.