Xeomin Reimbursement Support

Our reimbursement specialists have been trained to understand coverage and reimbursement for XEOMIN^® and can assist you in the areas below. If you do not require support in all of these areas, we can customize the level of XEOMIN support we provide to meet the needs of your patients and your practice.

General Billing, Coding and Coverage Information

• General billing and coding information for XEOMIN
• Quarterly Medicare Allowable (View current Medicare ASP information published by CMS)
• Information to assist in accurate Xeomin claim filing
• Information regarding the use of coding modifiers if required by the payor
• Information regarding current coverage for XEOMIN

For patients who have been determined appropriate for XEOMIN treatment by their physician:

Insurance Verification

• Patient insurance eligibility and coverage for XEOMIN (medical and/or pharmacy benefit and specialty pharmacy options)
• Patient co-payment and out-of-pocket expenses
• Supporting documentation requirements established by the payor.

Prior Authorization (PA)

• Payor prior authorization/pre-certification/pre-determination requirements for Xeomin
• Sample Letter of Medical Necessity
• Re-certification reminders
• PA denials*

Denials and appeals* for patients treated with XEOMIN

• Review denied/rejected/underpaid claims and explanation of benefits (EOBs)
• Research payer requirements for reopening/reprocessing/redetermination/appeal
• Sample Letter of Appeal

*Reimbursement staff can provide assistance with PA denials and Appeals for approved indications only and can help research the reason for denial in the case of unapproved uses.

Regional Reimbursement Team

Our regionally located individuals are available to provide support and assistance to you and your practice for XEOMIN.

The Regional Reimbursement Team can help your office with:

• Billing and coding for XEOMIN
• Payor specific requirements for chart documentation, MAUs, coding requirements, injection frequency restrictions
• Education on regional and national reimbursement trends
• Insurance verification (IV) and prior authorization (PA) best practices for Xeomin claims
• Payor trends
• Information regarding coverage for XEOMIN