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Xiaflex-new treatment for Dupuytren's contractures

  1. #1
    Cool Xiaflex-new treatment for Dupuytren's contractures
    Exam Training Packages
    Is anyone using Xiaflex yet and if so how are you coding? I see a public meeting is scheduled for CMS' to determine an appropriate specific J-code for this on 05/04/10, but I was curious if anyone has billed this as J3590 and 26989 and if so how successful was reimbursement? It has been indicated by the manufacturer that Medicare (Cahaba specifically) has indicated they would cover, but I have my doubts.

  2. #2
    we had a meeting w/ a xiaflex rep and they make it sound good but the reimbursement is minimal if reimbursable at all. i did some research online and their stocks are dropping because doctors just find it to risky to use. first off one vial of the stuff cost over $3000 and i read that they are predicting reimburesment to be around $250 that includes the ov, the injection, and the manipulation!!!! the unlisted j codes are what we were told to use for the moment until a permanent one has been assigned but they did not offer any other coding suggestions as far as the injection itself or the manipulation the day after

  3. #3
    Jamaica/ Manhattan
    this is as per Medicare
    Day 1
    • HCPCS code J3590-Unclassified biologic
    • CPT code 20550-Injection; single tendon sheath, or ligament
    • Submit the following information in the electronic documentation record (2400-NTE, 02), or for a paper claim in Item 19 or as an attachment to the CMS-1500 claim form.
    o NDC number
    o Drug name-Xiaflex
    o Dose given
    • For accurate payment, the drug and the administration service must be submitted on the same claim.
    Day 2
    • CPT code 99213-E/M includes manipulation(s) of the finger and local anesthesia or analgesia
    • CPT code 29130-splint application

  4. #4
    has anyone done any yet, and i am curious have they gotten paid?


  5. Default
    Hi Zena

    I was wondering, since you are in Tn, if you had try to bill for the J3590, Xiaflex. We had a rep here today and I was trying to find out if anybody knows how Cahaba pays. He stated for Medicare we had to bill for the medicine, which means we would have to pay for it too. He also stated that we could bill for office and injection on the first day and then on the second day we would be able to bill for office visit and manipulation. Just wondering if you have had any luck on this.

    Sherry Plunkett

  6. #6
    Greater East Tennessee
    We are in Tennessee and have billed for and been paid by Cahaba Medicare for one Xiaflex injection so far. We have performed 3 other injections by non-Cahaba patients and the patient's specialty pharmacy send the drugs direct to us. We used J3590 and 20550 on day 1 and the 26989 for day 2.

  7. Default
    I am wondering what CPT code you are using as a comparrison code for the unlisted 26989?


  8. #8
    what was the medicare reimbursement?

  9. #9
    Sorry, i haven't been on in a while. We have not billed the drug itself yet. We wanted to work out the bugs with the administration first. Good thing. Great product, but their road is going to be the two years it takes all new procedures to get a code. Luckily they are in the home stretch and maybe by February we will try again.

    We used comparision code 27430 for the 26989, carefully documenting that anesthesia was local only and that no joint was manipulated, only the persistent cord left intact after the injection to achieve full extension. Still appealing and awaiting final outcome. If you speak with the reps document that they will do your appeals for you and hold them to it because the man-hours have made this a negative investment so far.

  10. Default Xiaflex Documentation

    Check this attachment for billing Xiaflex injection. I think this may help you.

    ShashiKumar. N
    Attached Files Attached Files

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