We have resources and support programs for you, your practice, and your patients. From reimbursement support to advocacy groups, we’re here to help.
The Next Steps Support Line is a phone and Web-based resource available for your convenience. Specialists are available to help you take the next steps toward supporting patient access to XEOMIN therapy.
Highly trained experts are ready to assist you with:
The tables below summarize potential coding scenarios for XEOMIN in select situations for approved indications. Coverage, coding, and reimbursement will differ by payor. This information is intended to be a general guide for coding that the payor may recognize and/or prefer. Providers should check with the payor prior to submitting a claim to confirm the preferred code.
The procedure codes and diagnosis codes shown are provided as examples only. The practitioner must determine, based on independent medical judgment, whether to use XEOMIN for the specified treatment of his or her patient(s) and must supply the appropriate diagnosis codes to the XEOMIN Next Steps Support Line for the treatment provided.
* ICD-10-CM includes multiple diagnosis codes to describe upper limb spasticity. Please refer to your ICD-10 coding handbook to determine the most applicable code. It will be important for providers to confirm coding for upper limb spasticity with the patient’s health insurance payor based on the patient’s medical records.
(The labeler codes in these NDCs are for Merz North America, Inc.)
This coding information related to XEOMIN is intended solely for educational purposes. Information should not be construed as legal advice nor is it advice about how to code, complete, bill, or submit any particular claim for payment. This coding information is subject to change and may be outdated. It is the provider’s responsibility to determine appropriate codes, charges, and modifiers, and to submit bills for services and products consistent with what was rendered as well as the patient’s insurer requirements. Third-party payors may have different coverage and reimbursement policies and coding requirements. Such policies can change over time. Providers are encouraged to contact third-party payors for each patient to verify specific information on their coding policies.
Standard resources such as those below should be utilized to determine the appropriate coding information for XEOMIN treatment.
Health care providers should follow good documentation practices when treating patients with XEOMIN therapy. Good practices include but are not limited to:
Not doing so may cause delayed claims processing and payment or in some cases denial of a claim. In addition, good documentation is critical for a successful payor chart audit.
Billers should understand the contracts and other policy guidelines for various payors, including:
This form should be completed if you would like us to verify patient insurance eligibility and coverage for XEOMIN (including medical and/or pharmacy benefit and specialty pharmacy options).Click Here to Download
This document is an example of a letter than can be sent on behalf of your patient to the payor to justify the medical necessity of XEOMIN.Click Here to Download
This letter is an example of a letter that can be sent to appeal a denied claim for XEOMIN.Click Here to Download
XEOMIN® (incobotulinumtoxinA) for injection, for intramuscular or intraglandular use, is a prescription medicine that is used to treat adults with:
See full prescribing information for complete BOXED WARNING.
The effects of XEOMIN and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity but symptoms can also occur in adults, particularly in those patients who have underlying conditions that would predispose them to these symptoms.
Chronic Sialorrhea: The most commonly observed adverse reactions (incidence ≥3% of patients and greater than placebo) for XEOMIN were tooth extraction (5%), dry mouth (4%), diarrhea (4%), hypertension (4%), fall (3%), bronchitis (3%), dysphonia (3%), back pain (3%) and dry eye (3%).
Upper Limb Spasticity: The most commonly observed adverse reactions (incidence ≥2% of patients and greater than placebo) for XEOMIN were seizure (3%), nasopharyngitis (2%), dry mouth (2%), and upper respiratory tract infection (2%).
Cervical Dystonia: The most commonly observed adverse reactions (incidence ≥5% of patients and greater than placebo) for XEOMIN 120 Units and XEOMIN 240 Units, respectively, were: dysphagia (13%, 18%), injection pain site (9%, 4%), neck pain (7%, 15%), muscle weakness (7%, 11%), and musculoskeletal pain (7%, 4%).
Blepharospasm: The most commonly observed adverse reactions (incidence ≥5% of patients and twice greater than placebo) for XEOMIN were eyelid ptosis (19%), dry mouth (16%), dry eye (16%), visual impairment (12%), diarrhea (8%), headache (7%), dyspnea (5%) and nasopharyngitis (5%).
Co-administration of XEOMIN and aminoglycoside antibiotics or other agents interfering with neuromuscular transmission, e.g., tubocurarine-type muscle relaxants, should only be performed with caution as these agents may potentiate the effect of the toxin.
Use of anticholinergic drugs after administration of XEOMIN may potentiate systemic anticholinergic effects. The effect of administering different botulinum toxin products at the same time or within several months of each other is unknown. Excessive neuromuscular weakness may be exacerbated by administration of another botulinum toxin prior to the resolution of the effects of a previously administered botulinum toxin.
There are no adequate data on the developmental risk associated with the use of XEOMIN in pregnant women. XEOMIN should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Safety and effectiveness of XEOMIN in patients less than 18 years of age have not been established.
Please see accompanying full Prescribing Information, including BOXED WARNING.