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Effective January 1, 2025: ASP+6% reimbursement for EXPAREL when billing with code J0666 across all outpatient surgical settings.

Effective January 1, 2025, the NOPAIN Act provides ASP+6% Medicare reimbursement in HOPDs2,3

  • The NOPAIN Act provides separate reimbursement for proven non-opioid pain management options such as EXPAREL, beginning January 1, 20252,3
  • This expands Medicare reimbursement beyond the ASC, where separate payment is already available for EXPAREL2,3
  • With EXPAREL and the NOPAIN Act, your health care system can provide best-in-class postsurgical outcomes for your HOPD and/or ASC patients while reducing your overall net cost to make a meaningful impact on overall opioid consumption2,4,5
Learn more about the NOPAIN Act open in new tab arrow Download our guide to implementing the NOPAIN Act download arrow

Pricing is subject to CMS updates.

ASP+6% = reimbursement of 106% of the average sales price.

ASC, ambulatory surgery center; CMS, Centers for Medicare & Medicaid Services; HOPD, hospital outpatient department; NOPAIN, Non-Opioids Prevent Addiction in the Nation.

EXPAREL is reimbursed for procedures performed in HOPDs or ASCs using the code J0666 and for dental procedures using code D9613*

J0666: For procedures performed in HOPDs or ASCs6

Effective January 1, 2025, the CMS has granted a unique, product-specific billing code, or J-code, J0666, for EXPAREL used in HOPDs and ASCs.† To learn more, click here.

As of January 1, 2025

J0666 1 mg = 1 unit.

Allowed amount for reimbursement:

$385.70‡

266 mg (20 mL) dose

$192.85‡

133 mg (10 mL) dose

Ordering and Billing EXPAREL

D9613: For dental procedures

D9613 is defined as the infiltration of a sustained-release therapeutic drug, per quadrant, which allows for EXPAREL reimbursement in oral surgery procedures.

OMFS Coding Guide

*As of July 1, 2024; pricing subject to CMS Medicare updates. Pacira cannot guarantee reimbursement.

†For dates of service prior to January 1, 2025, Medicare reimbursement is available in ASCs when billing with C9290. For commercial or Medicare Advantage plans, please confirm with the individual payer.6

‡The allowed amount for reimbursement is based on the full dose being used for the surgical procedure.

OMFS, Oral and Maxillofacial Surgery.

For more information, contact our dedicated reimbursement specialists at reimbursement@pacira.com or call our Reimbursement Helpline at 1-855-793-9727.

Important Notice

Indication

EXPAREL® (bupivacaine liposome injectable suspension) is indicated to produce postsurgical local analgesia via infiltration in patients aged 6 years and older and regional analgesia in adults via an interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and an adductor canal block. Safety and efficacy have not been established in other nerve blocks.

Important Safety Information

  • EXPAREL is contraindicated in obstetrical paracervical block anesthesia.
  • Adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via infiltration were nausea, constipation, and vomiting; adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via nerve block were nausea, pyrexia, headache, and constipation.
  • Adverse reactions with an incidence greater than or equal to 10% following EXPAREL administration via infiltration in pediatric patients six to less than 17 years of age were nausea, vomiting, constipation, hypotension, anemia, muscle twitching, vision blurred, pruritus, and tachycardia.
  • Do not admix lidocaine or other non-bupivacaine local anesthetics with EXPAREL. EXPAREL may be administered at least 20 minutes or more following local administration of lidocaine.
  • EXPAREL is not recommended to be used in the following patient populations: patients <6 years old for infiltration, patients younger than 18 years old for nerve blocks, and/or pregnant patients.
  • Because amide-type local anesthetics, such as bupivacaine, are metabolized by the liver, EXPAREL should be used cautiously in patients with hepatic disease.

Warnings and Precautions Specific to EXPAREL

  • Avoid additional use of local anesthetics within 96 hours following administration of EXPAREL.
  • EXPAREL is not recommended for the following types or routes of administration: epidural, intrathecal, regional nerve blocks other than interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and adductor canal block, or intravascular or intra-articular use.
  • The potential sensory and/or motor loss with EXPAREL is temporary and varies in degree and duration depending on the site of injection and dosage administered and may last for up to 5 days, as seen in clinical trials.

Warnings and Precautions for Bupivacaine-Containing Products

  • Central Nervous System (CNS) Reactions: There have been reports of adverse neurologic reactions with the use of local anesthetics. These include persistent anesthesia and paresthesia. CNS reactions are characterized by excitation and/or depression.
  • Cardiovascular System Reactions: Toxic blood concentrations depress cardiac conductivity and excitability, which may lead to dysrhythmias, sometimes leading to death.
  • Allergic Reactions: Allergic-type reactions (eg, anaphylaxis and angioedema) are rare and may occur as a result of hypersensitivity to the local anesthetic or to other formulation ingredients.
  • Chondrolysis: There have been reports of chondrolysis (mostly in the shoulder joint) following intra-articular infusion of local anesthetics, which is an unapproved use.
  • Methemoglobinemia: Cases of methemoglobinemia have been reported with local anesthetic use.

Please refer to full Prescribing Information.

References

  1. Gorfine SR, Onel E, Patou G, Krivokapic ZV. Bupivacaine extended release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Dis Colon Rectum. 2011;54(12):1552-1559.
  2. Consolidated Appropriations Act 2023. Accessed November 1, 2024. https://www.congress.gov/117/bills/hr2617/BILLS-117hr2617enr.pdf;
  3. CMS.gov 2024. Medicare Part B drug average sales price. Accessed November 1, 2024. https://www.cms.gov/medicare/payment/fee-for-service-providers/part-b-drugs/average-drug-sales-price;
  4. Schwartz G, et al. A phase 3 active-controlled trial of liposomal bupivacaine via sciatic nerve block in the popliteal fossa after bunionectomy. J Clin Anesth. 2024;94:111402. doi:10.1016/j.jclinane.2024.111402;
  5. Gadsden J, et al. Liposomal bupivacaine via adductor canal block after total knee arthroplasty: a randomized, double-blind, phase 3 trial. Poster presented at: 48th Annual Regional Anesthesiology and Acute Pain Medicine Meeting; April 20, 2023; Hollywood, FL. Poster 4381.
  6. CMS.gov. Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS) Application Summaries and Coding Recommendations: Third Quarter, 2024 HCPCS Coding Cycle. Published October 2, 2024. Accessed November 1, 2024. https://www.cms.gov/files/document/2024-hcpcs-application-summary-quarter-3-2024-drugs-and-biologicals-posted-10-02-2024.pdf
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EXPAREL® (bupivacaine liposome injectable suspension) is indicated to produce postsurgical local analgesia via infiltration in patients aged 6 years and older and regional analgesia in adults via an interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and an adductor canal block. Safety and efficacy have not been established in other nerve blocks.

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