Countdown toNOPAIN Act:
Days
ASP+6% reimbursement for EXPAREL with code J0666 and expanded reimbursement for iovera° with code C9809 across outpatient settings as of 1/1/2025
Effective January 1, 2025
NOPAIN Act provides expanded reimbursement for EXPAREL and iovera°1,2
ASP+6% CMS reimbursement when billing EXPAREL with new code J0666 and expanded reimbursement when billing iovera° with new code C9809 across outpatient settings3,4*
*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; 4. Federal Register. Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs, including the Hospital Inpatient Quality Reporting Program; Health and Safety Standards for Obstetrical Services in Hospitals and Critical Access Hospitals; Prior Authorization; Requests for Information; Medicaid and CHIP Continuous Eligibility; Medicaid Clinic Services Four Walls Exceptions; Individuals Currently or Formerly in Custody of Penal Authorities; Revision to Medicare Special Enrollment Period for Formerly Incarcerated Individuals; and All-Inclusive Rate Add-On Payment for High-Cost Drugs Provided by Indian Health Service and Tribal Facilities. Published November 27, 2024. Accessed December 5, 2024. https://www.federalregister.gov/documents/2024/11/27/2024-25521/medicare-and-medicaid-programs-hospital-outpatient-prospective-payment-and-ambulatory-surgical
