EXPAREL J Code and NOPAIN ACT - Effective January 1, 2025

EFFECTIVE JANUARY 1, 2025

NEW J-CODE FOR EXPAREL: J0666

For EXPAREL use across all outpatient settings for Non-Opioid alternatives

CMS has granted a unique J-code, J0666, for EXPAREL use across all outpatient settings. J0666 is effective for dates of service on or after January 1, 2025 and replaces the temporary C-code (C9290) previously used for billing EXPAREL in outpatient settings.¹

EXPAREL is a long-lasting non-opioid option proven to manage postsurgical pain. More than 14 million patients have received non-opioid EXPAREL since 2012. EXPAREL works locally at the surgical site and uses the proprietary multivesicular liposome (pMVL) technology, which encapsulates bupivacaine in a suspension of multivesicular liposomes. After injection, bupivacaine is released over time.

HCPCS Information:

HCPCS Code	J0666
HCPCS Code Descriptor	Injection, bupivacaine liposome, 1 mg
HCPCS Code Dosage	1 MG

NDC Information:

NDC Code	Package Description	Billing Units per Package
65250-0133-04	4 single-dose vials containing 133mg/10 mL (13.3mg/mL) of EXPAREL	532
65250-0133-09	10 single-dose vials of 133mg/10 mL (13.3mg/mL) of EXPAREL	1330
65250-0266-04	4 single-dose vials of 266mg/20 mL (13.3mg/mL) of EXPAREL	1064
65250-0266-09	10 single-dose vials of 266mg/20 mL (13.3mg/mL) of EXPAREL	2660

Reimbursement is expanding for EXPAREL, thanks to the NOPAIN Act^2,3

The NOPAIN Act—effective January 1, 2025—mandates that Medicare provide ASP+6% reimbursement for qualifying non-opioids, like EXPAREL, across all outpatient settings

This expands Medicare reimbursement beyond the ASC setting (where EXPAREL is already reimbursed) to include the HOPD setting.

While Medicare reimbursement goes into effect on January 1, 2025, your efforts are crucial to ensure that your commercial members and network providers can access proven non-opioid options that can reduce opioid consumption.

Learn More About the NOPAIN Act

If you would like to speak to a representative of Pacira about EXPAREL, please contact your Account Director at Reimbursement@Pacira.com.

Indication

EXPAREL® (bupivacaine liposome injectable suspension) is indicated to produce postsurgical local analgesia via infiltration in patients aged 6 years and older and regional analgesia in adults via an interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and an adductor canal block. Safety and efficacy have not been established in other nerve blocks.

Important Safety Information

EXPAREL is contraindicated in obstetrical paracervical block anesthesia.
Adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via infiltration were nausea, constipation, and vomiting; adverse reactions reported in adults with an incidence greater thanor equal to 10% following EXPAREL administration via nerve block were nausea, pyrexia, headache, and constipation.
Adverse reactions with an incidence greater thanor equal to 10% following EXPAREL administration via infiltration in pediatric patients six to less than 17 years of age were nausea, vomiting, constipation, hypotension, anemia, muscle twitching, vision blurred, pruritus, and tachycardia.
Do not admix lidocaine or other non-bupivacaine local anesthetics with EXPAREL. EXPAREL may be administered at least 20 minutes or more following local administration of lidocaine.
EXPAREL is not recommended to be used in the following patient populations: patients <6 years old for infiltration, patients younger than 18 years old for nerve blocks, and/or pregnant patients.
Because amide-type local anesthetics, such as bupivacaine, are metabolized by the liver, EXPAREL should be used cautiously in patients with hepatic disease.

Warnings and Precautions Specific to EXPAREL

Avoid additional use of local anesthetics within 96 hours following administration of EXPAREL.
EXPAREL is not recommended for the following types or routes of administration: epidural, intrathecal, regional nerve blocks other than interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and adductor canal block, or intravascular or intra-articular use.
The potential sensory and/or motor loss with EXPAREL is temporary and varies in degree and duration depending on the site of injection and dosage administered and may last for up to 5 days, as seen in clinical trials.

Warnings and Precautions for Bupivacaine-Containing Products

Central Nervous System (CNS) Reactions: There have been reports of adverse neurologic reactions with the use of local anesthetics. These include persistent anesthesia and paresthesia. CNS reactions are characterized by excitation and/or depression.
Cardiovascular System Reactions: Toxic blood concentrations depress cardiac conductivity and excitability, which may lead to dysrhythmias, sometimes leading to death.
Allergic Reactions: Allergic-type reactions (eg, anaphylaxis and angioedema) are rare and may occur as a result of hypersensitivity to the local anesthetic or to other formulation ingredients.
Chondrolysis: There have been reports of chondrolysis (mostly in the shoulder joint) following intra-articular infusion of local anesthetics, which is an unapproved use.
Methemoglobinemia: Cases of methemoglobinemia have been reported with local anesthetic use.

Full Prescribing Information is available at www.EXPARELpro.com.

For more information, please visit www.EXPARELpro.com or call 1-855-793-9727.

References: 1. CMS.gov. Published October 10, 2024. Accessed October 4, 2024. https://www.cms.gov/files/document/2024-hcpcs-applica-tion-summary-quarter-3-2024-drugs-and-biologicals-posted-10-02-2024.pdf; 2. Consolidated Appropriations Act 2023. Accessed June 5, 2024. https://www.congress.gov/117/bills/hr2617/BILLS-117hr2617enr.pdf; 3. CMS.gov. 2024. Accessed June 4, 2024. https://www.cms.gov/medicare/ payment/fee-for-service-providers/part-b-drugs/average-drug-sales-price.

Parsippany, NJ 07054. PP-EX-US-9725 10/24