Trends in Anesthesiology

Pacira BioSciences, Inc. announced that the Centers for Medicare & Medicaid Services (CMS) issued its final Medicare Hospital Outpatient Prospective Payment System and Medicare Ambulatory Surgical Center (ASC) Payment System rule for 2025, which implements the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act that mandated separate Medicare payment for qualifying nonopioid drugs and devices. In the final rule, CMS confirmed that both EXPAREL^® (bupivacaine liposome injectable suspension) and iovera° qualify as eligible nonopioid pain management products under the NOPAIN Act.

Hospital outpatient departments (HOPDs) and ASCs that use these products will receive additional Medicare reimbursement beginning January 1, 2025.

Congress passed the NOPAIN Act as part of the Consolidated Appropriations Act of 2023 to provide better patient access to nonopioid drugs and devices used to manage pain in the HOPD and ASC settings, by offering additional Medicare reimbursement for qualifying nonopioid items.

The reimbursement rate for EXPAREL equates to 106% of the average sales price (ASP +6%) in the HOPD and ASC environments using the new product-specific J-code (J0666) beginning January 1, 2025. The separate reimbursement for iovera° will pay up to an additional $255.85 when providers administer iovera° in ASC and HOPD settings, using a new C-code created for the iovera° system (C9809). This new Medicare payment is provided in addition to the current reimbursement available to HOPDs and ASCs when they perform a procedure with the iovera° system.

Source: asamonitor.pub/3NUXtWs