The Merz Reimbursement Field Team has been trained to understand coverage and reimbursement for XEOMIN. Specialists are available to assist you with supporting patient access to XEOMIN therapy.
Highly trained experts are ready to assist you with:
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
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 MERZ CONNECT 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.)
‐ CPT codes 64642 and 64644 are considered primary codes and
only 1 code may be reported per patient per date of service
‐ Add-on codes
Disclaimer: Merz North America, Inc., has developed the XEOMIN coding and billing information to provide a general overview of coverage, coding, and claim submission information relevant to XEOMIN and associated services. This summary 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. It is important to check with the health plan directly to confirm coverage for individual patients. This coding and reimbursement information is subject to change and may be outdated. Merz disclaims any responsibility for claims submitted by providers or physicians and does not guarantee that payors will consider all codes appropriate for all encounter scenarios or that coverage and reimbursement will result. The key in all coding and billing to payors is to be truthful and not misleading and make full disclosures to the payor about the product and the procedures associated with its use when seeking reimbursement for any product or procedure. It is the provider’s and physician’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.
Healthcare 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:
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.
The most commonly observed adverse reactions at rates specified below and greater than placebo are:
Chronic Sialorrhea: (≥4% of patients) tooth extraction, dry mouth, diarrhea, and hypertension.
Upper Limb Spasticity: (≥2% of patients) seizure, nasopharyngitis, dry mouth, upper respiratory tract infection.
Cervical Dystonia: (≥5% of patients) dysphagia, neck pain, muscle weakness, injection site pain, and musculoskeletal pain.
Blepharospasm: (≥10% of patients) eyelid ptosis, dry eye, visual impairment, and dry mouth.
Co-administration of XEOMIN and aminoglycoside or other agents interfering with neuromuscular transmission, (e.g., 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.