CABLIVI (caplacizumab-yhdp) dots

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.


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
M31.1 Thrombotic Microangiopathy
  ICD-10-PCS Code3

Introduction of Caplacizumab Into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 5

Introduction of Other Therapeutic Substance into Subcutaneous Tissue, Percutaneous Approach


Introduction of Caplacizumab Into Peripheral Vein, Percutaneous Approach, New Technology Group 5

Introduction of Other Therapeutic Substance into Peripheral Vein, Percutaneous Approach


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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CABLIVI Billing and Coding Guide

Find more information regarding coverage and other
reimbursement considerations.

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CABLIVI Hospital Guide

This guide highlights key information related to the
procurement of, and patient access to, CABLIVI.

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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.