Wiki Xiaflex

[drakowski]

We have given Xiaflex and Medicare has paid well but not the full amount they stated they would reimburse. We should be reimbursed 3k give or take by Medicare for this injection but we are seeing payments of about 1k less.

The dose is .58 mg and the drug is billed for each .01mg so we bill the code 58 times. The outside billing company states we are short reimbursement because the the drug plus diluent equals 90 mg and that we should bill for the total dose which includes discard?? This does not make sense to me.

Has anyone out there billed for Xiaflex and received the full reimbursement from Medicare in MI? Please advise.

Thanks. Debbie

 

[OCD_coder]

Here is the Manufacturer's link to assist with your billing needs. It appears that 90 units of J0775 would be the correct amount to send in to receive proper payment by CMS.

http://hcp.xiaflex.com/Documents/0811-025.d_PRG.pdf

 

[drakowski]

Thanks.

 

[dstruve]

I do not bill the full amount like the xiaflex brochure shows. I billed for the amount we used and then the amount discarded with a JW modifier. We have always been paid.