Access & Reimbursement | EXPAREL® (bupivacaine liposome injectable suspension)

Overview

More Patients & Providers Can Now Access Non-Opioid Pain Management Options Like EXPAREL

Expanded Reimbursement Measures Include^1-3:

Separate payment in ASCs since 2019
Medicare reimbursement at ASP+6% under the NOPAIN Act (effective 1/1/25), expanding EXPAREL coverage for millions of patients

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

ASC, ambulatory surgery center; ASP, average selling price; NOPAIN, Non-Opioids Prevent Addiction in the Nation.

Learn how Medicare reimbursement can help offset the cost of EXPAREL so that more patients and providers have access with reduced financial barriers.

Understanding Medicare Reimbursement

Additional Initiatives Further Improve Access to EXPAREL

Partnerships with major GPOs, IDNs and ASCs to ensure systems have access to contract pricing, which will reduce overall net costs
Access for eligible 340B facilities to discounted products for indigent patients
Product-specific codes for streamlined reimbursement and billing, increasing recognition and coverage by commercial payers⁴
- J0666 for procedures performed in outpatient procedures
- D9613 for dental procedures

ASC, ambulatory surgery center; CMS, Centers for Medicare & Medicaid Services; GPO, Group Purchasing Organization;

IDN, integrated delivery network.

Reimbursement

Navigating Reimbursement:  Codes for EXPAREL

EXPAREL is Reimbursed for Procedures Performed in Outpatient Procedures Using the Code J0666 and for Dental Procedures Using Code D9613

J0666: For Procedures Performed in Outpatient Settings⁴

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

J0666 1 mg = 1 unit

As of July 1, 2025

Allowed Medicare amount for reimbursement^†: $1.493/mg

$397.14^‡

266 mg (20 mL) dose

$198.57^‡

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

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

*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

^†As of July 1, 2025; pricing subject to CMS Medicare updates. Pacira cannot guarantee reimbursement

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

ASC, ambulatory surgery center; CMS, Centers for Medicare & Medicaid Services.

NOPAIN Act

The NOPAIN Act Mandates That Medicare Reimburse for Qualified Non-Opioids, Like EXPAREL, Across All Outpatient Settings^5,6

The bipartisan and bicameral NOPAIN Act was designed to increase patient and provider access to non-opioid pain management options by removing the barriers associated with reimbursement for the Medicare population. With Congress passing the NOPAIN Act, you can now provide branded non-opioids—like EXPAREL—to your Medicare patients for improved management of postsurgical pain while minimizing financial barriers.^2,5,7

Congress has mandated that Medicare provide expanded reimbursement for qualifying non-opioid options.^5,6

The NOPAIN Act will expand access across outpatient procedures.⁵

The NOPAIN Act will cover reimbursement for drugs and devices that have demonstrated the ability to reduce or avoid intraoperative or postoperative opioid use, including EXPAREL.^5,7,8

The Act was designed to take steps to stop future addiction before it can begin by ensuring that Medicare patients have access to non-opioids while dealing with postsurgical pain.^2,5

NOPAIN, Non-Opioids Prevent Addiction in the Nation.

EXPAREL Coverage Support

Below are tools to support you if you need to request coverage for EXPAREL or challenge a denied claim.

Letter of Medical Necessity Template

Supports your practice in communicating the clinical rationale for EXPAREL use, tailored to your patient’s needs.

Download Form

Letter of Denial Appeal Template

Provides a structured format to request claim consideration.

Download Form

Clinical & Economic Outcomes

EXPAREL Is a Cost-Effective Option for Postsurgical Pain Management in the Outpatient Settings

EXPAREL is available in 133 mg (10 mL) dose for $241.29 and 266 mg (20 mL) dose for $398.69. The 133 mg (10 mL) and 266 mg (20 mL) doses of EXPAREL are available in cartons of 4 and 10 vials. For more information please visit How to order EXPAREL.

Select Procedure Type

Information below helps review the value of EXPAREL in a multimodal pain management protocol that can lead to fewer opioids,*  better pain control, and shorter LOS. These, in turn, can lead to fewer patient complications and reduced hospital costs per patient.

Please select a procedure & study to see associated clinical and economic outcomes.

*The clinical benefit of the decrease in opioid consumption was not demonstrated in pivotal trials LOS, length of stay.

Unilateral, Single-level Transforaminal lumbar Interbody Fusion: Medical Center in Massachusetts¹¹
Study Methods
37 adult patients undergoing unilateral, single-level TLIF with EXPAREL compared with a historic control for the same procedure (N=74)
Retrospective, observational study matched 1:1 to controls
Surgical and treatment protocol was the same for both groups. In the EXPAREL group, EXPAREL was infiltrated at the conclusion of surgery in addition to the standard, nonliposomal local anesthetic received by the control group
Cost was analyzed from the hospital perspective and savings per procedure were determined by the mean total costs for patients in both groups
Means and standard deviations were analyzed for all presurgical and postsurgical outcomes
Safety Outcomes
The overall rate of complications was identical in both groups (8.1%)
No adverse events were attributed to the use of EXPAREL
Clinical and Economic Outcomes
Patients who received ERP with EXPAREL to manage pain after surgery had
Significantly better pain control reported in the first 24 hours^†
0 to 12 hours: 15.0 vs 45.6 (P=0.003)
12 to 24 hours: 37.6 vs 48.4 (P=0.05)
34% fewer opioids used at 12 to 24 hours^‡
12 to 24 hours: 16.0 vs 24.1 (P=0.04)
1.2 days shorter LOS
3.1 vs 4.3 days (P<0.001)
$590 lower mean total per-patient cost
$14,816 vs $15,406
ERP alone (n=37)
Standard postsurgical treatment protocol
Acetaminophen
Oral and intravenous narcotics
Oxycodone or hydromorphone
Muscle relaxants
Cyclobenzaprine, diazepam, or tizanidine
Received an intraoperative injection of lidocaine or bupivacaine hydrochloride
ERP with EXPAREL (n=37)
Identical ERP as in ERP-alone group
Local infiltration into the surgical site with EXPAREL expanded with saline and bupivacaine hydrochloride
The clinical benefit of the decrease in opioid consumption was not demonstrated in the clinical trials
^†Pain was self-reported by patients using the visual analog scale. Scores recorded over the first 3 days were divided into 12-hour intervals and used to calculate the area under the curve
^‡Opioid consumption was measured using intravenous morphine milligram equivalent
TLIF, transforaminal lumbar interbody fusion; ERP, enhanced recovery protocol; LOS, length of stay.

Implant-Based Breast Reconstruction: Medical Center in California¹²
Study Methods
12 adult patients undergoing mastectomy with EXPAREL compared with 12 adult patients undergoing mastectomy with bupivacaine
Prospective, randomized, single-blind trial
Basic statistical analyses were performed and included pain scores, opioid consumption, benzodiazepine consumption, antiemetic consumption, LOS, and hospital costs
Safety Outcomes
No significant adverse events were noted in either group
Clinical and Economic Outcomes
In patients who received EXPAREL for analgesia
47% lower opioid consumption during hospital stay^†
0.76 vs 1.43 MED/hour
22.6 vs 66.8 for entire LOS duration^‡
16.9 hours  shorter LOS
29.8 vs 46.7 hours
$7804 lower  hospital charges
$10,828 vs $18,632
Breast reconstruction with EXPAREL (n=12)
Intrasurgical injection of 1.3% EXPAREL, with 10 mL (133 mg) delivered to perform a field block of each breast pocket
Infiltration sites included the pectoralis major muscle, along the ipsilateral parasternal line, along a line 1 cm posterior and parallel to the anterior axillary line, extending under the pectoralis major muscle in the axilla, the base of the mastectomy flaps, and any locations where deep sutures were placed to anchor acellular dermal matrices along the chest wall and pectoralis major muscle
Standard postoperative drug regimen for pain (hydrocodone/acetaminophen and/or hydromorphone), muscle spasms (diazepam), and nausea and vomiting (ondansetron)
Included 3 unilateral and 9 bilateral procedures
Breast reduction with bupivacaine (n=12)
Intrasurgical injection of 0.25% bupivacaine and epinephrine (1:200,000), with 20 mL (50 mg) delivered to perform a field block of each breast pocket^§
Infiltration sites included the pectoralis major muscle, along the ipsilateral parasternal line, along a line 1 cm posterior and parallel to the anterior axillary line, extending under the pectoralis major muscle in the axilla, the base of the mastectomy flaps, and any locations where deep sutures were placed to anchor acellular dermal matrices along the chest wall and pectoralis major muscle
Standard postoperative drug regimen for pain (hydrocodone/acetaminophen and/or hydromorphone), muscle spasms (diazepam), and nausea and vomiting (ondansetron)
Included 2 unilateral and 10 bilateral procedures
The clinical benefit of the decrease in opioid consumption was not demonstrated in the clinical trials
^†Opioid consumption was noted and converted to MED per hour of hospital stay
^‡Projected value calculated using study data for each respective cohort. The EXPAREL figure is based on 0.76 MED/hour and a 29.8-hour LOS. The bupivacaine figure is based on 1.43 MED/hour and a 46.7-hour LOS
^§The use of EXPAREL in combination with epinephrine is not part of the approved label
LOS, length of stay; MED, morphine equivalent dosing.

Implant-Based Breast Reconstruction: Medical Center in Illinois¹³
Study Methods
Adult patients (N=90) undergoing mastectomy and immediate implant-based breast reconstruction with or without lymph node dissection. All patients had the same postsurgical pain control regimens with hydromorphone hydrochloride PCA or morphine PCA, were transitioned to oral narcotics on the first postsurgical day, and received the same postsurgical orders, including as-needed antinausea medications, pruritus medications, and scheduled cyclobenzaprine. Patients were divided into 3 groups based on analgesia:
Patients who received EXPAREL
Patients who received NDB in a pain pump
Patients in the control group who received IV PCA or oral narcotics
Retrospective chart review
Multiple linear regression analyses were performed to assess how identified factors impacted LOS
Safety Outcomes
No complications were noted in the EXPAREL group
Clinical and Economic Outcomes
In patients who received EXPAREL for analgesia
Significantly better pain control (P<0.01) 4, 8, 12, 16, and 24 hours postsurgery^†
Significantly lower pain versus  NDB and PCA
67% patients discharged home after 1 day
EXPAREL group: 20 of 30 (67%)
NDB group: 13 of 30 (43%)
Control group: 9 of 30 (30%)
Breast reconstruction with EXPAREL (n=30)
20 mL of EXPAREL were infiltrated in unilateral breast reconstruction
20 mL of EXPAREL were expanded with 10 mL of saline in bilateral breast reconstruction, with 15 mL total infiltrated into each breast
Included 6 unilateral and 24 bilateral procedures
Patients who received implantation of an ADM had an additional 3 mL of EXPAREL infiltrated around the suture sites. All patients in this group received an ADM
Breast reconstruction with NDB pump (n=30)
Pain pump placed in subpectoral plane underneath implant in a pocket separate from the drain
Included 14 unilateral and 16 bilateral procedures
Breast reconstruction with PCA/oral narcotics control group (n=30)
No regional anesthesia or intraoperative lidocaine or bupivacaine
IV PCA or oral narcotics
Included 14 unilateral and 16 bilateral procedures
*The clinical benefit of the decrease in opioid consumption was not demonstrated in the clinical trials
^†All pain was measured with the visual analog scale
ADM, acellular dermal matrix; IV, intravenous; NDB, non-depot bupivacaine; PCA, patient-controlled analgesia; LOS, length of stay.

Abdominally Based Microsurgical Breast Reconstruction: Medical Center in New York¹⁴
Study Methods
128 adult patients undergoing breast reconstruction using abdominally based free flaps with or without a non-narcotic protocol using intraoperative TAP blockade. Patients were divided into a control group, a TAP catheter group, and a TAP EXPAREL group
Retrospective observational study
Primary and secondary outcomes were assessed for associations and adjusted for confounding variables
Safety Outcomes
The overall complication rate was 8.7%, with no significant differences between the groups
The TAP catheter group noted higher rates of transfusions (P=0.0084)
Clinical and Economic Outcomes
In patients who received EXPAREL for analgesia
Fewer total opioids used after surgery vs catheter and control groups (mg)^†
Day 0–1: 1.88 vs 7.25 (P=0.0081) vs 52.86 (P<0.0001)
Day 2: 2.12 vs 5.17 (P=0.0270) vs 29.9 (P=0.0009)
0.9 to 1.4 days shorter LOS
EXPAREL group: 2.65 days
TAP catheter group: 3.52 days
Control group: 4.05 days
Breast reconstruction with TAP EXPAREL (n=40)
15 mg of IV ketorolac and 1000 mg of IV acetaminophen at the end of surgery and then every 6 hours postsurgery
After tolerance of an oral diet, patients switched to an oral regimen of 10 mg of ketorolac and 650 mg of acetaminophen, with oral opioids as needed for breakthrough pain
A mixture of 20 mL of 1.3% EXPAREL, 30 mL of standard bupivacaine, and 80 mL of normal saline infiltrated at 30 mL into each side
After tolerance of an oral diet, patients switched to an oral regimen of 10 mg of ketorolac and 650 mg of acetaminophen, with oral opioids as needed for breakthrough pain
Breast reconstruction with TAP catheter (n=48)
15 mg of IV ketorolac and 1000 mg of IV acetaminophen at the end of surgery and then every 6 hours postsurgery
After tolerance of an oral diet, patients switched to an oral regimen of 10 mg of ketorolac and 650 mg of acetaminophen, with oral opioids as needed for breakthrough pain
30 mL of 0.25% bupivacaine injected bilaterally, followed by transcutaneous passing of bilateral epidural catheters into the plane and connected to a 400-mL capacity fixed-rate pump filled with 0.25% bupivacaine delivered through each catheter at 2 mL per hour
Breast reconstruction with narcotic-based analgesia control group (n=40)
Standard narcotic-based analgesia regimen without locoregional anesthesia
IV PCA opioid pump with additional nurse-administered opioids for breakthrough pain, followed by transition to an as-needed oral opioid
The clinical benefit of the decrease in opioid consumption was not demonstrated in the clinical trials
^†Opioid consumption was measured using IV morphine equivalent (mg)
TAP, transversus abdominis plane.

Microvascular Breast Reconstruction: Medical Center in Minnesota¹⁵
Study Methods
49 adult patients undergoing microvascular breast reconstruction with EXPAREL as part of an ERAS protocol compared with 51 adult patients undergoing microvascular breast reconstruction with TRAS before development of the ERAS protocol
Retrospective cohort study
Characteristics were compared between the 2 groups, and a multivariable regression analysis was used on continuous outcome variables to account for baseline differences between the 2 groups
Safety Outcomes
No significant differences between the 2 groups in relation to 30-day complications
The ERAS group experienced an increased incidence of native breast skin flap cellulitis compared with the group without ERAS (20% vs 6%, respectively; P=0.03)
Clinical and Economic Outcomes
In patients who received EXPAREL for analgesia
Significantly better pain control (P=0.02) 24 hours postsurgery^†
24 hours: 3.3 vs 4.1 (P=0.02)
71% fewer total opioids used postsurgery (mg)^‡
Total: 167.3 vs 574.3 (P<0.001)
Day 1: 67.3 vs 260.9 (P<0.001)
Day 2: 53.5 vs 192.2 (P<0.001)
Day 3: 39.0 vs 113.1 (P<0.001)
1.6 days shorter  LOS postsurgery
Total: 3.9 vs 5.5 days (P<0.001)
Microvascular reconstruction with EXPAREL as part of ERAS (n=49)
All procedures included use of EXPAREL expanded with saline and infiltrated as a subfascial TAP block into the rectus sheath(s) and into subcutaneous tissues at the lower abdominal incision
Local anesthesia or pain pump catheters were not used
Included 9 unilateral and 40 bilateral procedures
Microvascular reconstruction with TRAS (n=51)
5 procedures included use of EXPAREL prior to standardization of EXPAREL use as part of all ERAS procedures
EXPAREL was expanded with saline and infiltrated as a subfascial TAP block into the rectus sheath(s) and into subcutaneous tissues at the lower abdominal incision
Included use of local anesthesia and pain pump catheters
Included 10 unilateral and 41 bilateral procedures
The clinical benefit of the decrease in opioid consumption was not demonstrated in the clinical trials
^†All pain was measured using the visual analog scale
^‡Parenteral and oral opioid intake was converted into oral morphine equivalents (mg) using standardized calculations
ERAS, enhanced recovery after surgery; TRAS, traditional recovery after surgery; LOS, length of stay.

Cesarean Section: Medical Center in Texas¹⁷
Study Methods
Adult patients (N=201) who underwent elective, unscheduled waiting list, or emergency cesarean delivery with an EXPAREL TAP block (n=101) compared with patients who did not receive an EXPAREL TAP block (n=100)
Retrospective chart review
Safety Outcomes
Patients treated with EXPAREL reported fewer adverse events, such as nausea, vomiting, or pruritus (34% vs 50%; P=0.026)
Clinical and Economic Outcomes
In patients who received EXPAREL for analgesia
Significantly better pain control (P<0.001)
132.8 vs 246.3 (P<0.001) of total AUC of NRS pain scores from 0 to 3 days
47% reduction in postsurgical opioid consumption through 3 days*
Total postsurgical opioid consumption (MED), mg: 41.9 vs 79.6 (P<0.001)
1 Day shorter LOS
26% reduction in LOS (2.9 days vs  3.9 days; P<0.001)
19% reduction in time to discharge readiness (2.9 days vs 3.6 days; P=0.006)
15% reduction in PACU discharge readiness time (25 minutes)
138 minutes vs 163 minutes (P=0.028)
39% reduction in time to ambulation
18.7 hours vs 30.7 hours; P<0.001
Multimodal protocol (n=100)
Spinal-epidural anesthesia with intrathecal morphine and supplemental IV analgesia
Supplemental analgesia was based on patient reported pain scores^†
NRS 1 to 5: 3 doses of IV acetaminophen 10 mg/mL (15 mg/kg if body weight <50 kg) every 6 hours alternating with 3 doses of IV ketorolac 30 mg every 6 hours for 24 hours
NRS 6 to 10: IV nalbuphine 2 mg every 2 hours as needed for breakthrough pain for 24 hours
Multimodal protocol with EXPAREL TAP block (n=101)
Ultrasound-guided TAP block with EXPAREL 266 mg/20 mL admixed with 30 mL of bupivacaine HCl 0.25% and 30 mL of normal saline, equaling 40 mL injected on each side (total volume: 80 mL)
Spinal-epidural anesthesia with intrathecal morphine and supplemental IV analgesia
Supplemental analgesia was based on patient reported pain scores^†
NRS 1 to 5: 3 doses of IV acetaminophen 10 mg/mL (15 mg/kg if body weight <50 kg) every 6 hours alternating with 3 doses of IV ketorolac 30 mg every 6 hours for 24 hours
NRS 6 to 10: IV nalbuphine 2 mg every 2 hours as needed for breakthrough pain for 24 hours
*The clinical benefit of the decrease in opioid consumption was not demonstrated in the clinical trials
^†The NRS scale used ranged from 0, representing no pain, to 10, representing the worst possible pain
AUC, area under the curve; NRS, numerical rating scale; TAP, transversus abdominis plane; LOS, length of stay; MED, morphine equivalent doses; PACU, postanesthesia care unit.

Total Hip Arthroplasty: ASCs in Tennessee¹⁸
Study Methods
145 outpatient THAs in 125 patients performed with the use of EXPAREL by a single surgeon in 2 separate stand-alone ASCs
Retrospective chart review
Safety Outcomes
1 recognized intraoperative fracture, which did not compromise same-day discharge
5 unanticipated complications (3.4%) in global period postsurgery
Clinical and Economic Outcomes
In patients who received EXPAREL to manage pain after surgery
Complication rates compared favorably with those reported after standard inpatient THA
99.3% of cases did not require a transfer to the hospital for transfusion
0% of patients required other direct admissions to the hospital or ED
Average surgical time was 71 minutes and total LOS was 10.8 hours
98% of cases did not require surgical intervention within a 90-day period
Persistent drainage 6 weeks postsurgery that required debridement/irrigation with head/liner exchange
Periprosthetic fracture from a same-level fall at home 7 days postsurgery that required revision surgery
Outpatient superficial wound revision, 4 weeks postsurgery
THA (N=145)
Preoperative regimen - Oral celecoxib 400 mg, gabapentin 300 mg, oxycodone 10 or 20 mg, and oral or intravenous acetaminophen 1000 mg
Intraoperative regimen - 0.75% bupivacaine with 8.25% dextrose 10 to 15 mg spinal, EXPAREL 266 mg infiltrated into wound, and intravenous dexamethasone 4 to 8 mg
Postsurgical regimen - Oral celecoxib 200 mg 4 times daily or meloxicam 7.5 mg 2 times daily, oral gabapentin 300 mg 2 times daily, oral tramadol 50 mg every 6 hours, oral acetaminophen 1000 mg every 8 hours, and oral oxycodone 5 to 10 mg every 4 to 6 hours as needed
Spinal anesthesia was used in 132 procedures with bupivacaine (10.5-15 mg) and general endotracheal anesthesia was used in 13 patients due to previous spinal fusion, preexisting neuropathy, or intraoperative conversion secondary to unsuccessful spinal anesthesia
Included 105 unilateral procedures and 20 bilateral procedures
*The clinical benefit of the decrease in opioid consumption was not demonstrated in the clinical trials
ASC, ambulatory surgery center; ED, emergency department; LOS, length of stay; THA, total hip arthroplasty.

Total Joint Arthroplasty Study^19,20: Medicare and Commercial
Background
Two studies analyzed the impact that EXPAREL, as part of an ERAS pathway, had on same-day discharge. The Medicare-focused study analyzed the outcome and feasibility of same-day discharge using an ERAS protocol in the inpatient setting, while the commercial insurance-focused study analyzed outcomes in an ASC.
Medicare: Orthopedic center in Oregon
Commercial: ASC in Oregon
Study Methods
Medicare and Commercial: Retrospective chart review
Medicare: 601 unique patients who underwent primary TKA (n=337) or THA (n=308) with the use of EXPAREL
Commercial: 220 unique patients who underwent primary TKA (n=113) or THA (n=138) with the use of EXPAREL in a freestanding ASC
Safety Outcomes
Medicare: Within 30 days after surgery, 1.1% of patients experienced a severe AE and 0.5% of patients experienced a minor AE
Commercial: Within 30 days after surgery, 6 patients experienced a severe AE and 1 patient experienced a minor AE
Clinical and Economic Outcomes
In patients who received EXPAREL for analgesia
Same-day discharge
Medicare: 84% of patients were discharged on the day of surgery
Commercial: 100% of patients were discharged on the day of surgery
High pain management satisfaction
Medicare: 98.3% of patients were “very much” or a “good amount” satisfied with pain management
Commercial: 99.3% of patients were “very much” or a “good amount” satisfied with pain management
Postsurgical opioid use
Medicare: 84.2% of patients did not require an opioid prescription beyond the initial 7-day prescription provided at discharge*
TJA: Medicare (N=601) and commercial (N=220)
Individualized preoperative opioid analgesia protocol
Non-opioid analgesia protocol consisting of acetaminophen, meloxicam, or celecoxib utilized 1 week before surgery and for 6 weeks after surgery
Spinal anesthesia
Periarticular infiltration with EXPAREL 266 mg, bupivacaine HCl, and adjuncts
Restricted intravenous opioids during surgery
THA: Medicare (n=308) and commercial (n=138)
Anterior lateral femoral cutaneous nerve field block with EXPAREL 266 mg and bupivacaine HCl
TKA: Medicare (n=337) and commercial (n=113)
Adductor canal block with bupivacaine HCl
*The clinical benefit of the decrease in opioid consumption was not demonstrated in the pivotal trials
AE, adverse event; ASC, ambulatory surgery center; ERAS, enhanced recovery after surgery; THA, total hip arthroplasty; TJA, total joint arthroplasty; TKA, total knee arthroplasty.

Total Joint Arthroplasty: Freestanding ASC in Illinois²¹
Study Methods
115 adult patients undergoing total joint arthroplasty (TJA)
37 total hip arthroplasties (THAs)
53 total knee arthroscopies (TKAs)
25 unicompartmental knee arthroplasties (UKAs)
Retrospective cohort review
Safety Outcomes
There was 1 incident of a 30-day complication
Intertrochanteric femur fracture treated with nonsurgical management
There were 4 incidents of 90-day complications
2 incidents of arthrofibrosis treated with manipulation under anesthesia
1 incident of patellar tendon rupture during therapy treated with surgical repair
1 incident of hematogenous infection treated with a 2-stage exchange arthroplasty
There were 0 incidents of intrasurgical complications, blood transfusions, hospital admissions, adverse events within the ASC, venous thromboembolisms, or readmissions for postsurgical pain
Clinical and Economic Outcomes
In patients who received EXPAREL for analgesia
100% discharge rate to home for all patients
135 minutes of average recovery time for hip procedures^†
132 minutes of average recovery time for knee procedures^†
0 readmissions for postsurgical pain
TJA protocol (N=115)
Presurgical regimen of celecoxib, when not contraindicated, hydrocodone or oxycodone based on the surgeon’s preference, and gabapentin
Presurgical intravenous (IV) antibiotic administration
General anesthesia for all patients, with regional adductor blocks for patients undergoing TKA or UKA
Intrasurgical pericapsular injection of EXPAREL, epinephrine, morphine, bupivacaine, and ketorolac^‡
Intrasurgical IV or topical tranexamic acid based on the surgeon’s preference
Postsurgical pain management included celecoxib, oxycodone, or hydrocodone based on the surgeon’s preference with a minimization  of IV narcotic administration
Prophylaxis for venous thromboembolism included enteric-coated aspirin 325 mg twice per day and mobile calf pumps, warfarin,  or enoxaparin sodium based on the surgeon’s preference
*The clinical benefit of the decrease in opioid consumption was not demonstrated in the clinical trials
^†Recovery duration started with the transfer of the patient from the operating room to the postanesthesia care unit and concluded at the discharge of the patient from the ASC
^‡The use of EXPAREL in combination with epinephrine is not part of the approved label
TJA, total joint arthroplasty; THA, total hip arthroplasty; TKA, total knee arthroplasty; UKA, unicondylar knee arthroplasty; ASC, ambulatory surgery center.

Total Joint Arthroplasty: ASC in New Jersey²²
Study Methods
51 consecutive TJA procedures performed with the use of EXPAREL by 3 fellowship-trained adult reconstruction surgeons
Procedures included THA, TKA, and UKA
Retrospective review of outpatient medical records and preoperative and postsurgical clinical charts
Safety Outcomes
All adverse events were minor and treated within the ASC without the need for overnight observation or hospitalization
Clinical and Economic Outcomes
In patients who received EXPAREL for analgesia
84% of patients surveyed (n=19) reported pain level as expected and well controlled
0% of patients required an ED visit for uncontrolled pain and postsurgical transfusion
0% of patients experienced a  reported adverse event that required prolonged care or hospitalization
98% of patients were discharged to home
1 THA patient elected to go to a rehabilitation facility prior to surgery
80% of patients surveyed (n=19) would recommend the ASC to friends and family
TJA protocol (N=51)
Preoperative regimen: 1 dose each of celecoxib, oxycodone hydrochloride extended release, and gabapentin
Perioperative regimen: 1 dose of intravenous acetaminophen and 2 doses of intravenous dexamethasone
Intraoperative regimen^†: Periarticular injection of EXPAREL, epinephrine, morphine, methylprednisolone, and cefazolin in 20 mL of normal saline
Postsurgical regimen: Celecoxib, oxycodone hydrochloride extended release for 7 days, and oxycodone for breakthrough pain
THA (n=22)
Average surgical time was 132 minutes and total LOS was 6.3 hours
Received a lumbar epidural catheter in preoperative holding and propofol sedation intraoperatively
TKA (n=15)
Average surgical time was 130 minutes and total LOS was 7.1 hours
Received a single-dose femoral nerve block, a single-dose tibial nerve block, and an adductor canal catheter block in preoperative holding
UKA (n=14)
Average surgical time was 130 minutes and total LOS was 6.2 hours
Received a single-dose femoral nerve block, a single-dose tibial nerve block, and an adductor canal catheter block in preoperative holding
*The clinical benefit of the decrease in opioid consumption was not demonstrated in the clinical trials
^†The use of EXPAREL in combination with epinephrine is not part of the approved label
TJA, total joint arthroplasty; TKA, total knee arthroplasty; UKA, unicondylar knee arthroplasty.

How to Order

Opening an Account & How to Order EXPAREL

Order EXPAREL directly* from Pacira BioSciences, Inc.

*Payment is by credit card only

Bill J0666 when using EXPAREL across all outpatient settings.

See Billing Guide

EXPAREL NDC Codes

Ordering for EXPAREL

EXPAREL 133 mg (10 mL) and 266 mg (20 mL) are available to order in cartons of 4 or 10 vials.

As of March 20, 2017, there are 4 SKUs of EXPAREL available.

Configuration	Dose/vial size	NDC #
Carton of 10 vials	EXPAREL 266 mg/20 mL	65250-266-09
Carton of 4 vials	EXPAREL 266 mg/20 mL	65250-266-04
Carton of 10 vials	EXPAREL 133 mg/10 mL	65250-133-09
Carton of 4 vials	EXPAREL 133 mg/10 mL	65250-133-04

NDC, National drug code.

Billing for EXPAREL

EXPAREL 133 mg (10 mL) and 266 mg (20 mL) is supplied in single-dose vials, with each vial being billed individually.

Configuration	Dose/vial size	NDC #
Single-dose vial	EXPAREL 133 mg/10 mL	65250-133-10
Single-dose vial	EXPAREL 266 mg/20 mL	65250-266-20

NDC, National drug code.

For First-Time Orders

You must have an account with Pacira to make direct orders. If you do not have an account, fill out a Letter of Affiliation
Fax the form to (855) 803-9481 with
- A copy of your facility license
- A business card or letterhead displaying the same address

Note: This should be done immediately before calling to place an order.

If you are practicing in the state of Florida, you will also need to fill out and submit the Health Care Clinic Establishment form

All purchases are subject to Pacira's General Terms & Conditions and Return Goods Policy

References

CMS to pay separately for Exparel, non-opioid pain management at ASCs in 2018. Becker’s ASC Review. Published November 13, 2018. Accessed March 10, 2025. https://www.beckersasc.com/asc-news/cms-to-pay-separately-for-exparel-non-opioid-pain-management-at-ascs-in-2018/
Voices for non-opioid choices. Voices for non-opioid choices coalition applauds Congress for expanding access to non-opioid pain management options in end-of-year legislative package to combat addiction crisis. Published December 23, 2022. Accessed March 10, 2025. https://nonopioidchoices.org/wp-content/uploads/2022/12/Voices-Press-Statement-NOPAIN-Act-Passage-12.23.22.pdf
Pacira BioSciences, Inc. Centers for Medicare and Medicaid Services (CMS) establishes additional payment for iovera in outpatient settings. Published November 4, 2024. Accessed March 10, 2025. https://investor.pacira.com/node/17676/pdf
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 March 10, 2025. https://www.cms.gov/files/document/2024-hcpcs-application-summary-quarter-3-2024-drugs-and-biologicals-posted-10-02-2024.pdf
Consolidated Appropriations Act 2023. Accessed March 18, 2025. https://www.congress.gov/117/bills/hr2617/BILLS-117hr2617enr.pdf
CMS.gov. Medicare part B drug average sales price. Updated October 29, 2024. Accessed March 18, 2025. https://www.cms.gov/medicare/payment/fee-for-service-providers/part-b-drugs/average-drug-sales-price
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. Accessed March 18, 2025. https://www.federalregister.gov/documents/2024/11/27/2024-25521/medicare-and-medicaid-programs-hospital-outpatient-prospective-payment-and-ambulatory-surgical
CMS.gov. CY 2025 Medicare hospital outpatient prospective payment system and ambulatory surgical center payment system proposed rule (CMS 1809-P). Published July 10, 2024. Accessed March 18, 2025. https://www.cms.gov/newsroom/fact-sheets/cy-2025-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center
Keller DS, Pedraza R, Tahilramani RN, Flores-Gonzalez JR, Ibarra S. Impact of long-acting local anesthesia on clinical and financial outcomes in laparoscopic colorectal surgery. Am J Surg. 2017;214(1):53-58.
Wang MY, Chang HK, Grossman J. Reduced acute care costs with the ERAS® minimally invasive transforaminal lumbar interbody fusion compared with conventional minimally invasive transforaminal lumbar interbody fusion. Neurosurgery. 2018;83(4):827-834.
Kim J, Burke SM, Kryzanski JT, et al. The role of liposomal bupivacaine in reduction of postoperative pain after transforaminal lumbar interbody fusion: a clinical study. World Neurosurg. 2016;91:460-467.
Motakef S, Wong WW, Ingargiola MJ, et al. Liposomal bupivacaine in implant-based breast reconstruction. Plast Reconstr Surg Glob Open. 2017;5(11):e1559.
Butz DR, Shenaq DS, Rundell VL, et al. Postoperative pain and length of stay lowered by use of EXPAREL in immediate, implant-based breast reconstruction. Plast Reconstr Surg Glob Open. 2015;3(5):e391.
Jablonka EM, Lamelas AM, Kim JN, et al. Transversus abdominis plane blocks with single-dose liposomal bupivacaine in conjunction with a nonnarcotic pain regimen help reduce length of stay following abdominally based microsurgical breast reconstruction. Plast Reconstr Surg. 2017;140(2):240-251.
Batdorf NJ, Lemaine V, Lovely JK, et al. Enhanced recovery after surgery in microvascular breast reconstruction. J Plast Reconstr Aesthet Surg. 2015;68(3):395-402.
Hutchins J, Vogel RI, Ghebre R, et al. Ultrasound-guided subcostal transversus abdominis plane infiltration with liposomal bupivacaine for patients undergoing robotic-assisted hysterectomy: a retrospective study. Int J Gynecol Cancer. 2015;25(5):937-941.
Baker BW, Villadiego LG, Lake YN, et al. Transversus abdominis plane block with liposomal bupivacaine for pain control after cesarean delivery: a retrospective chart review. J Pain Res. 2018;11:3109-3116.
Toy PC, Fournier MN, Throckmorton TW, Mihalko WM. Low rates of adverse events following ambulatory outpatient total hip arthroplasty at a free-standing surgery center. J Arthroplasty. 2018;33(1):46-50.
Van Horne A, Van Horne J. Presurgical optimization and opioid-minimizing enhanced recovery pathway for ambulatory knee and hip arthroplasty: postsurgical opioid use and clinical outcomes. Arthroplast Today. 2019;6(1):71-76.
Van Horne A, Van Horne J. Patient-optimizing enhanced recovery pathways for total knee and hip arthroplasty in Medicare patients: implication for transition to ambulatory surgery centers. Arthroplast Today. 2019;5(4):497-502.
Shah RR, Cipparrone NE, Gordon AC, Raab DJ, Bresch JR, Shah NA. Is it safe? Outpatient total joint arthroplasty with discharge to home at a freestanding ambulatory surgical center. Arthroplast Today. 2018;4(4):484-487.
Parcells BW, Giacobbe D, Macknet D, et al. Total joint arthroplasty in a stand-alone ambulatory surgical center: short-term outcomes. Orthopedics. 2016;39(4):223-228.
Mont MA, Beaver WB, Dysart SH, Barrington JW, Del Gaizo DJ. Local infiltration analgesia with liposomal bupivacaine improves pain scores and reduces opioid use after total knee arthroplasty: results of a randomized controlled trial. J Arthroplasty. 2018;33(1):90-96.
Patel M, Gadsden JC, Nedeljkovic SS, et al. Brachial plexus block with liposomal bupivacaine for shoulder surgery improves analgesia and reduces opioid consumption: Results from a multicenter, randomized, double-blind, controlled trial. Pain Med. 2020;21(2):387-400.
Routman HD, Israel LR, Moor MA, Boltuch AD. Local injection of liposomal bupivacaine combined with intravenous dexamethasone reduces postoperative pain and hospital stay after shoulder arthroplasty. J Shoulder Elbow Surg. 2017;26(4):641-647.

Expanded Reimbursement Measures Mean Greater Access

Overview

More Patients & Providers Can Now Access Non-Opioid Pain Management Options Like EXPAREL

Expanded Reimbursement Measures Include1-3:

Learn how Medicare reimbursement can help offset the cost of EXPAREL so that more patients and providers have access with reduced financial barriers.

Understanding Medicare Reimbursement

Additional Initiatives Further Improve Access to EXPAREL

GET ON-DEMAND SUPPORT

for prescribing EXPAREL with our easy-to-use portal.

Reimbursement

Navigating Reimbursement: Codes for EXPAREL

EXPAREL is Reimbursed for Procedures Performed in Outpatient Procedures Using the Code J0666 and for Dental Procedures Using Code D9613

J0666: For Procedures Performed in Outpatient Settings4

J0666 1 mg = 1 unit

$397.14‡

$198.57‡

D9613:

For Dental Procedures

NOPAIN Act

The NOPAIN Act Mandates That Medicare Reimburse for Qualified Non-Opioids, Like EXPAREL, Across All Outpatient Settings5,6

MAKE THE PACT TODAY

Commit to bringing the NOPAIN Act to your health system.

EXPAREL Coverage Support

Clinical & Economic Outcomes

EXPAREL Is a Cost-Effective Option for Postsurgical Pain Management in the Outpatient Settings

Select Procedure Type

Laparoscopic Colorectal Surgery: Medical Center in Texas9

Minimally Invasive Surgery - Transforaminal Lumbar Interbody Fusion: Medical Center in Florida10

Unilateral, Single-level Transforaminal lumbar Interbody Fusion: Medical Center in Massachusetts11

Implant-Based Breast Reconstruction: Medical Center in California12

Implant-Based Breast Reconstruction: Medical Center in Illinois13

Abdominally Based Microsurgical Breast Reconstruction: Medical Center in New York14

Microvascular Breast Reconstruction: Medical Center in Minnesota15

Gynecologic Oncology Robotic-Assisted Hysterectomy: Medical Center in Minnesota16

Cesarean Section: Medical Center in Texas17

Total Hip Arthroplasty: ASCs in Tennessee18

Total Joint Arthroplasty Study19,20: Medicare and Commercial

Total Joint Arthroplasty: Freestanding ASC in Illinois21

Total Joint Arthroplasty: ASC in New Jersey22

Total Knee Arthroplasty: 16 US Centers23

Total Shoulder Arthroplasty or Rotator Cuff Repair: 16 International Study Sites24

Shoulder Arthroplasty: Hospital in Florida25

How to Order

Opening an Account & How to Order EXPAREL

EXPAREL NDC Codes

Ordering for EXPAREL

Billing for EXPAREL

For First-Time Orders

Expanded Reimbursement Measures Include^1-3:

Navigating Reimbursement:  Codes for EXPAREL

J0666: For Procedures Performed in Outpatient Settings⁴

$397.14^‡

$198.57^‡

The NOPAIN Act Mandates That Medicare Reimburse for Qualified Non-Opioids, Like EXPAREL, Across All Outpatient Settings^5,6

Laparoscopic Colorectal Surgery: Medical Center in Texas⁹

Minimally Invasive Surgery - Transforaminal Lumbar Interbody Fusion: Medical Center in Florida¹⁰

Unilateral, Single-level Transforaminal lumbar Interbody Fusion: Medical Center in Massachusetts¹¹

Implant-Based Breast Reconstruction: Medical Center in California¹²

Implant-Based Breast Reconstruction: Medical Center in Illinois¹³

Abdominally Based Microsurgical Breast Reconstruction: Medical Center in New York¹⁴

Microvascular Breast Reconstruction: Medical Center in Minnesota¹⁵

Gynecologic Oncology Robotic-Assisted Hysterectomy: Medical Center in Minnesota¹⁶

Cesarean Section: Medical Center in Texas¹⁷

Total Hip Arthroplasty: ASCs in Tennessee¹⁸

Total Joint Arthroplasty Study^19,20: Medicare and Commercial

Total Joint Arthroplasty: Freestanding ASC in Illinois²¹

Total Joint Arthroplasty: ASC in New Jersey²²

Total Knee Arthroplasty: 16 US Centers²³

Total Shoulder Arthroplasty or Rotator Cuff Repair: 16 International Study Sites²⁴

Shoulder Arthroplasty: Hospital in Florida²⁵