XEOMIN® Access and Support

We have resources and support programs for you, your practice, and your patients. From reimbursement support to advocacy groups, we’re here to help.

For Your Practice For Your Patients

The Next Steps Field Team

The XEOMIN Next Steps Field Team and Next Steps Support Line—a Total Team Approach.

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:

Call toll-free 1-844-4MyMerz (1-844-469-6379) to reach a Next Steps specialist

Click Here to Register for or Log in to the XEOMIN eSupport site

XEOMIN Billing & Reimbursement Support

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.

Patient Diagnosis Codes

* 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.

Drugs & Biologics

(The labeler codes in these NDCs are for Merz North America, Inc.)

Professional Services

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 This coding information is subject to change and may be outdated.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.

Below are example best practices that may facilitate XEOMIN billing, coding, and reimbursement processes.

1. Utilize standard billing and coding resources

Standard resources such as those below should be utilized to determine the appropriate coding information for XEOMIN treatment.

2. Good clinical documentation

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.

3. Understand relevant third-party payor coverage and reimbursement

Billers should understand the contracts and other policy guidelines for various payors, including:

Downloadable Forms

Insurance Verification Request Form

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
Sample Letter of Medical Necessity

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
Sample Appeal Letter

This letter is an example of a letter that can be sent to appeal a denied claim for XEOMIN.

Click Here to Download

Reference

  1. 2015 CPT Professional Edition. American Medical Association; 2014. Current Procedural Terminology (CPT®) copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.