The NOPAIN Act will provide separate ASP+6% Medicare reimbursement in HOPDs
HOPD reimbursement coming soon
Effective January 1, 2025, this new federal policy will provide separate reimbursement for proven non-opioid pain management options such as EXPAREL.
This will expand Medicare reimbursement beyond the ambulatory surgery center, where separate payment is already available via code C9290 for EXPAREL.
With EXPAREL and the NOPAIN Act, your health care system can provide best-in-class postsurgical outcomes for your HOPD and/or ASC patients while reducing your overall net cost to make a meaningful impact on overall opioid consumption.1-3
EXPAREL is reimbursed for procedures performed in ASCs using the code C9290 and for dental procedures using code D9613*
C9290: For procedures performed in ASCs
Effective January 1, 2019, the Centers for Medicare and Medicaid (CMS) Services reinstated a unique, product-specific billing code, or HCPCS code C9290, and Revenue code 0636 for EXPAREL in ASCs. To learn more, click here.
As of July 1, 2024
EXPAREL is reimbursed at $1.46/mg*
Allowed amount for reimbursement:
$388.36† 266 mg (20 mL) dose
$194.18† 133 mg (10 mL) dose
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.
For more information, contact our dedicated reimbursement specialists at reimbursement@pacira.com or call our Reimbursement Helpline at 1-855-793-9727.
Pricing is subject to CMS updates.
ASC, ambulatory surgery center; ASP, average sales price; CMS, Centers for Medicare and Medicaid Services; HCPCS, healthcare common procedure coding system; HOPD, hospital outpatient department; NOPAIN, Non-Opioids Prevent Addiction in the Nation.
*As of July 1, 2024; pricing subject to Centers for Medicare & Medicaid Services (CMS) Medicare updates.
†The allowed amount for reimbursement is based on the full dose being used for the surgical procedure.
