CMS, Dental Association Set Pay Code for Pacira Local Pain Med

Pacira Pharmaceuticals, Inc. (NSDQ: PCRX) today announced that the Centers for Medicare and Medicaid Services (CMS) has finalized a policy to provide separate Medicare reimbursement for EXPAREL^® (bupivacaine liposome injectable suspension) when administered in ambulatory surgical centers (ASCs) through establishment of the product-specific billing code of C9290. This code, which will provide payment for EXPAREL at average sales price (ASP) + 6%, sets national Medicare reimbursement rates for EXPAREL administered in ASCs. In addition, the American Dental Association has established a separate D-code (D9613) to reimburse for EXPAREL infiltration in oral surgery procedures. Both codes become effective on January 1, 2019.

“We are pleased to receive separate reimbursement from Medicare in the ASC, and also to receive the unique D-code for EXPAREL from the ADA. We believe these developments will significantly simplify the reimbursement process for clinicians and facilities utilizing the product, thus improving patient access and accelerating the transition of certain procedures to the ambulatory surgical center setting,” said Dave Stack, Chairman and Chief Executive Officer of Pacira. “We expect the reinstatement of C9290—the original C-code for EXPAREL, which is still utilized by some commercial payers— to facilitate a more efficient rollout among commercial payers as they standardize around Medicare rates and practices. Further, we believe the D-code will meaningfully enhance the use of EXPAREL in oral surgery procedures, where young adult patients are often exposed to an opioid for the first time.”

Healthcare providers and suppliers use the Healthcare Common Procedure Coding System (HCPCS) code set to identify items and services on claims submitted to Medicare and other payors.  HCPCS codes, such as the unique C code describing EXPAREL (C9290, injection, bupivacaine liposome) are used to report drugs, biologicals, and devices used in hospitals and ambulatory surgical settings.

EXPAREL is indicated for single-dose infiltration in adults to produce postsurgical local analgesia and as an interscalene brachial plexus nerve block to produce postsurgical regional analgesia. It has been used in over 4 million patients across the United States to date.

https://www.marketscreener.com/PACIRA-PHARMACEUTICALS-IN-7299436/news/Centers-for-Medicare-and-Medicaid-Services-and-American-Dental-Association-Establish-New-Reimburseme-27536177/