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ASP+6% reimbursement for EXPAREL effective January 1, 2025, when billing with code J0666 across all outpatient surgical settings
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Effective January 1, 2025
NOPAIN Act provides expanded reimbursement for EXPAREL® (bupivacaine liposome injectable suspension)1
ASP+6% CMS reimbursement when billing EXPAREL with new code J0666 across outpatient settings2,3*
*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.3
ASP+6% = reimbursement of 106% of the average sales price.
ASC, ambulatory surgical center; CMS, Centers for Medicare & Medicaid Services; NOPAIN, Non-Opioids Prevent Addiction in the Nation.
References: 1. Consolidated Appropriations Act 2023. Accessed October 30, 2024. https://www.congress.gov/117/bills/hr2617/BILLS-117hr2617enr.pdf; 2. CMS.gov. Medicare part B drug average sales price. Updated April 2, 2024. October 30, 2024. https://www.cms.gov/medicare/payment/fee-for-service-providers/part-b-drugs/average-drug-sales-price; 3. CMS.gov. Published October 10, 2024. Accessed October 30, 2024. https://www.cms.gov/files/document/2024-hcpcs-application-summary-quarter-3-2024-drugs-and-biologicals-posted-10-02-2024.pdf
