The XIAFLEX® Resource Center
Access downloadable forms and resources for your practice and your appropriate adult patients
Please print the full Prescribing Information, including Medication Guide.

Refer to this guide for instructions on the preparation and administration of XIAFLEX®

Use this form to enroll in the managed distribution program

Use this form to enroll your healthcare site in the managed distribution program

Learn about possible codes associated with XIAFLEX® treatment

Learn about specific clinical information typically required by payors in order to confirm coverage

An in-depth handbook for in-office use covering coding, planning, and preparation for reimbursement

A useful example that shows what the 1450 Form – Single Cord/Joint claim form looks like when properly filled out

A useful example that shows what the 1450 Form – Dual Cord/Joint, No Modifier Required claim form looks like when properly filled out

A useful example that shows what the 1450 Form – Dual Cord/Joint, Modifier Required claim form looks like when properly filled out

A useful example that shows what the 1500 Form – Single Cord/Joint claim form looks like when properly filled out

A useful example that shows what the 1500 Form – Dual Cord/Joint, No Modifier Required claim form looks like when properly filled out

A useful example that shows what the 1500 Form – Dual Cord/Joint, Modifier Required claim form looks like when properly filled out

Provides a detailed explanation pertaining to your patient's XIAFLEX® Copay Program, including terms and eligibility requirements

For patients to apply for copay reimbursement when XIAFLEX® is ordered through a Specialty Distributor

For patients who require financial assistance with their XIAFLEX® copay

Provides a patient-friendly overview of Dupuytren's contracture and treatment with XIAFLEX®

Use this form to initiate a benefits investigation

Use this form if additional support is needed to ensure coverage

Use this form to appeal a denied injection claim

Use this form to appeal a denied finger extension claim

Provides a patient-friendly overview of Dupuytren's contracture and treatment with XIAFLEX®

Provides a patient-friendly explanation of how to perform at-home finger exercises

Provides patient-friendly instructions to follow and potential side effects to be aware of after a XIAFLEX® procedure