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Treatment for adults with Dupuytren’s
contracture with a palpable cord

Are you new to or experienced with XIAFLEX®?

Whether your office is about to start or is already treating patients with XIAFLEX®, get quick access to key contact information, reminders, and forms

New to XIAFLEX®

Please print the full Prescribing Information, including Medication Guide.

Getting started with XIAFLEX® is easy

Complete and submit a Benefits Investigation Form by faxing it to 1-877-909-2337 OR submit the form online through the Endo Advantage portal

You can enroll your practice in the Endo Advantage portal to automate benefits verification and to track your patient's status.

To learn more, or if you have questions, call Endo Advantage at 1-877-XIAFLEX (1-877-942-3539) Monday through Friday, from 9:00 AM to 8:00 PM ET.

Specialty Distributor
(Buy and Bill)

  • Provider’s practice purchases XIAFLEX® prior to the procedure with just-in-time shipping to avoid holding inventory
  • Required for Medicare Part B
  • Preferred channel for many commercial payors and some state Medicaid programs

Specialty Pharmacy

  • Provider’s hospital or institution orders XIAFLEX® from US Bioservices with no upfront purchase of XIAFLEX®
  • US Bioservices handles shipping, benefits verification, claim filing, and bills the insurance plan directly for the drug
  • Payor coverage through many commercial payors, most state Medicaid programs

Wholesaler
(for institutional purchase only)

  • Provider’s hospital or institution purchases XIAFLEX® directly from a wholesaler prior to the procedure and submits a claim to the patient's insurer for the drug and the physician services

For more information, see helpful tips and reminders or call Endo Advantage at 1-877-XIAFLEX (1-877-942-3539), Monday through Friday, from 9:00 AM to 8:00 PM ET.

NOTE: Insurers may require you to use a specific acquisition method.

For commercially insured patients

  • Most eligible patients with commercial insurance plans paid $0 copay through the XIAFLEX® Copay Assistance Program1*
  • The XIAFLEX® Copay Assistance Program can cover up to $1200 of out-of-pocket costs for each injection of XIAFLEX®

Download Copay Form

NOTE: This form is only needed for "buy-and-bill" reimbursement.

Patient Assistance Program

  • Endo Pharmaceuticals is committed to helping make treatment more affordable for eligible uninsured patients.

Download Application

*Based on analysis of claims filed September 2011 through March 2018.1
No other purchase is necessary to receive this offer. Restrictions apply. See full Terms and Conditions.

If using a specialty distributor

  • Submit a claim to the patient's insurer for the drug and the physician services

If using a specialty pharmacy

  • Bill the patient’s insurer for the physician services

For a full list of possible codes for XIAFLEX® reimbursement, see Claims Processing information below.

ClaimsProcessing

Possible codes for treating a single joint in 1 visit

XIAFLEX® billing for healthcare provider (HCP) offices, hospital outpatient departments, and ambulatory surgery centers

SINGLE JOINT

Click within each cell below to autocopy the code to your clipboard

NOTE: Coding is part of the clinical decision. Please use codes that most accurately reflect the procedures performed.
Suggestions by Endo Pharmaceuticals Inc. do not guarantee reimbursement or take the place of professional coding advice.

Injection Follow-up Visit
ICD-10-CM M72.0 Palmar fascial fibromatosis [Dupuytren] M72.0 Palmar fascial fibromatosis [Dupuytren]
procedure code
20527 Injection, enzyme (eg, collagenase), palmar fascial cord (ie, Dupuytren’s contracture)
26341 Manipulation, palmar fascial cord (ie, Dupuytren’s cord), post enzyme injection (eg, collagenase), single cord (10-day global)
29130 Application of finger splint; static
Drug Code J0775 (represents 0.01 mg of XIAFLEX®)
Commercial: Bill as 90 units
Medicare: Bill as 2 separate lines
Line 1: J0775 (58 units*)
Line 2: J0775 (32 units*) and apply the JW modifier
NA
Injection
ICD-10-CM
M72.0 Palmar fascial fibromatosis [Dupuytren]
procedure code
20527 Injection, enzyme (eg, collagenase), palmar fascial cord (ie, Dupuytren’s contracture)
Drug Code
J0775 (represents 0.01 mg of XIAFLEX®)
Commercial: Bill as 90 units
Medicare: Bill as 2 separate lines
Line 1: J0775 (58 units*)
Line 2: J0775 (32 units*) and apply the JW modifier

*These amounts are provided as an example of the recommended dose and wastage in accordance with the XIAFLEX® Prescribing Information.

Application of finger splint should be used only when the procedure is performed in a physician’s office.

SOURCES: ICD-10 Code Lookup. Centers for Medicare & Medicaid Services Website. Accessed February 8, 2018. CPT® 2012 Standard Edition.

Chicago, IL: American Medical Association; 2011.

Billing and Coding Guidelines. Centers for Medicare and Medicaid Services Website. Accessed February 8, 2018.

CPT® Code Detail - 29130. Optum360 EncoderPro. Accessed February 8, 2018.

JW Modifier: Drug amount discarded/not administered to any patient. Centers for Medicare and Medicaid Services Website. June 9, 2016. Accessed February 8, 2018.


Possible codes for treating 2 joints on the same hand in 1 visit

The codes used to describe single-joint treatment of adult patients with Dupuytren’s contracture with a palpable cord may also be used to describe treatment of up to 2 joints on the same hand during a treatment visit

2 JOINTS

Click within each cell below to autocopy the code to your clipboard

NOTE: Coding is part of the clinical decision. Please use codes that most accurately reflect the procedures performed.
Suggestions by Endo Pharmaceuticals Inc. do not guarantee reimbursement or take the place of professional coding advice.

Injection Follow-up Visit
ICD-10-CM M72.0 Palmar fascial fibromatosis [Dupuytren] M72.0 Palmar fascial fibromatosis [Dupuytren]
procedure code
20527 Injection, enzyme (eg, collagenase), palmar fascial cord (ie, Dupuytren’s contracture)
Bill as 2 units OR 2 separate lines of 1 unit
Line 1: 1 unit
Line 2: 1 unit and apply the most appropriate modifier
26341 Manipulation, palmar fascial cord (ie, Dupuytren’s cord), post enzyme injection (eg, collagenase), single cord (10-day global)
Bill as 2 units OR 2 separate lines of 1 unit
Line 1: 1 unit
Line 2: 1 unit and apply the most appropriate modifier
29130 Application of finger splint; static
Drug Code J0775 (represents 0.01 mg of XIAFLEX®)
Commercial: Bill as 180 units
Medicare: Bill as 2 separate lines
Line 1: J0775 (116 units)
Line 2: J0775 (64 units) and apply the JW modifier
NA
Injection
ICD-10-CM
M72.0 Palmar fascial fibromatosis [Dupuytren]
procedure code
20527 Injection, enzyme (eg, collagenase), palmar fascial cord (ie, Dupuytren’s contracture)
Bill as 2 units OR 2 separate lines of 1 unit
Line 1: 1 unit
Line 2: 1 unit and apply the most appropriate modifier
Drug Code
J0775 (represents 0.01 mg of XIAFLEX®)
Commercial: Bill as 180 units
Medicare: Bill as 2 separate lines
Line 1: J0775 (116 units)
Line 2: J0775 (64 units) and apply the JW modifier

It is possible that any given payor may accept or require a different coding paradigm for same-day, dual cord treatments such as the use of modifier (51, 76, 59, or XS) and/or billing service individually on separate line items.

If you have questions about XIAFLEX® coding, please contact Endo Advantage at 1-877-XIAFLEX (1-877-942-3539) or the payor’s Provider Service Representative.

Download Coding Table

Application of finger splint should be used only when the procedure is performed in a physician's office.

These amounts represent 58 units per cord/joint (total of 116 units) and wastage of 32 units per cord/joint (total of 64 units) and are provided as an example of the recommended dose and wastage in accordance with the XIAFLEX® Prescribing Information.

SOURCES: CPT® 2012 Standard Edition. Chicago, IL: American Medical Association; 2011. CPT is a registered trademark of the American Medical Association. Billing and Coding Guidelines. Centers for Medicare & Medicaid Services Website. Accessed February 8, 2018.

CPT® Code Detail - 29130. Optum360 EncoderPro. Accessed February 8, 2018.

JW Modifier: Drug amount discarded/not administered to any patient. Centers for Medicare and Medicaid Services Website. June 9, 2016. Accessed February 8, 2018.


Claims appeals

In case your claim is denied or not fully reimbursed:

  • Review your Explanation of Benefits to understand the reason(s) for the outcome
  • Contact your Endo Pharmaceuticals Reimbursement Specialist to help inform you about the information and materials you will need to gather for an appeal
  • Complete and submit the appeal within the time frame allowed in the appeals process

Experiencedwith XIAFLEX®

Please print the full Prescribing Information, including Medication Guide.

Key contact information, reminders, and forms to help you acquire XIAFLEX®

Access support

This program provides a point of contact for HCPs to help support patient access.

  • You can enroll your practice in the Endo Advantage portal to automate benefits verification and to track your patient’s status

Endo Advantage

Phone: 1-877-XIAFLEX(1-877-942-3539)

Fax: 1-877-909-2337

Specialty distributor reminders

  • Account set up is required
  • Besse Medical may offer up to 90 days to pay for the order

Besse Medical

Phone: 1-800-543-2111

Fax: 1-800-543-8695

Besse.com

Specialty pharmacy reminders

Tell patients to be alert for an incoming call or voicemail from US Bioservices. Due to current privacy laws (HIPAA), they may not specify why they are calling. XIAFLEX® will not be shipped until the patient verifies acceptance of the order via phone call.

  • Standard processing can take up to 2-3 weeks for shipment of medication
  • XIAFLEX® Copay Program automatically applied for eligible patients

US Bioservices

Phone: 1-855-534-8323

Fax: 1-888-418-7246

Usbioservices.com


Patients may pay as little as $0 with the XIAFLEX® Copay Program1

Eligibility requirements include:

  • Receiving or received XIAFLEX® for an approved indication and in a manner consistent with the instructions for administration of XIAFLEX®
  • Uninsured or have insurance that is not provided by Medicare, Medicare Prescription Drug Benefit plans, Medicare Advantage, Veterans Affairs (VA), Medicaid, or similar federal or state programs and the offer is not otherwise prohibited by law
  • 18 years of age or older
  • Patients who have paid or are obligated to pay out-of-pocket costs for a dose of XIAFLEX®
  • Patient has not used this program within the last 30 days

If you are ordering XIAFLEX® through a Specialty Distributor, remind your eligible patients to complete the XIAFLEX® Copay Program Reimbursement Form

No other purchase is necessary to receive this offer. Restrictions apply. See full Terms and Conditions.

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Important Safety Information
for XIAFLEX®

  • XIAFLEX® is contraindicated in patients with a history of hypersensitivity to XIAFLEX® or to collagenase used in any other therapeutic application or application method
  • In the controlled and uncontrolled portions of clinical trials in Dupuytren's contracture, flexor tendon ruptures occurred after XIAFLEX® injection. Injection of XIAFLEX® into collagen-containing structures such as tendons or ligaments of the hand may result in damage to those structures and possible permanent injury such as tendon rupture or ligament damage. Therefore, XIAFLEX® should be injected only into the collagen cord with a MP or PIP joint contracture, and care should be taken to avoid injecting into tendons, nerves, blood vessels, or other collagen-containing structures of the hand. When injecting a cord affecting a PIP joint of the fifth finger, the needle insertion should not be more than 2 to 3 mm in depth and avoid injecting more than 4 mm distal to the palmar digital crease
  • Other XIAFLEX®-associated serious local adverse reactions in the controlled and uncontrolled portions of the studies included pulley rupture, ligament injury, complex regional pain syndrome (CRPS), sensory abnormality of the hand, and skin laceration (tear). In a historically controlled post-marketing trial, the incidence of skin laceration (22%) was higher for subjects treated with two concurrent injections of XIAFLEX® compared with subjects treated with up to three single injections in the placebo-controlled premarketing trials (9%). Cases of skin laceration requiring skin graft after finger extension procedures have been reported post-marketing. Signs or symptoms that may reflect serious injury to the injected finger/hand should be promptly evaluated because surgical intervention may be required
  • In the controlled portions of the clinical trials in Dupuytren's contracture, a greater proportion of XIAFLEX®-treated patients (15%) compared to placebo-treated patients (1%) had mild allergic reactions (pruritus) after up to 3 injections. The incidence of XIAFLEX®-associated pruritus increased after more XIAFLEX® injections in patients with Dupuytren's contracture
  • Because XIAFLEX® contains foreign proteins, severe allergic reactions to XIAFLEX® can occur. Anaphylaxis was reported in a post-marketing clinical study in one patient who had previous exposure to XIAFLEX® for the treatment of Dupuytren's contracture. Healthcare providers should be prepared to address severe allergic reactions following XIAFLEX® injections
  • In the XIAFLEX® trials in Dupuytren's contracture, 70% and 38% of XIAFLEX®-treated patients developed an ecchymosis/contusion or an injection site hemorrhage, respectively. Patients with abnormal coagulation (except for patients taking low-dose aspirin, eg, up to 150 mg per day) were excluded from participating in these studies. Therefore, the efficacy and safety of XIAFLEX® in patients receiving anticoagulant medications (other than low-dose aspirin, eg, up to 150 mg per day) within 7 days prior to XIAFLEX® administration is not known. In addition, it is recommended to avoid use of XIAFLEX® in patients with coagulation disorders, including patients receiving concomitant anticoagulants (except for low-dose aspirin)
  • In the XIAFLEX® clinical trials for Dupuytren's contracture, the most common adverse reactions reported in ≥25% of patients treated with XIAFLEX® and at an incidence greater than placebo were edema peripheral (eg, swelling of the injected hand), contusion, injection site hemorrhage, injection site reaction, and pain in the injected extremity

Indication

XIAFLEX® is indicated for the treatment of adult patients with Dupuytren's contracture with a palpable cord.

Please see the full Prescribing Information, including Medication Guide.


  1. Reference:
  2. 1. Data on file. DOF-XDC-29. Endo Pharmaceuticals Inc; April 25, 2018.