Access and Reimbursement

If you have questions about ordering, coding, and reimbursement, we’re here to help.

Please note: the specifics of coverage may vary by payer and can be specific to the patient's unique plan. Please reference the individual patient's plan to determine applicable coverage.

3D red-blue horshoe-shaped magnet lying flat, to represent Andexxa's power to draw out FXa inhibitors 3D red-blue horshoe-shaped magnet lying flat, to represent Andexxa's power to draw out FXa inhibitors

Information on Coding, Billing and Reimbursement to assist with patient access to ANDEXXA.

Go to Access Site

How ANDEXXA® is supplied1

Carton NDC Number 69853-0102-1*
Carton Configuration
4 single-use vials in a carton
Each vial contains 200 mg
Vial Cap Color
Red flip-off cap
Andexxa box and vial sitting side-by-side, with description of packaging configuration and order number

*Medicaid and some commercial payers may require conversion of 10-digit NDCs to 11-digit NDCs for claims submission. Providers are responsible for verifying formatting requirements related to entry of NDCs on claims with payers.

Ordering information

ANDEXXA is available exclusively through these approved distributors:

Phone:1.800.746.6273
Fax:1.800.547.9413
Phone: 1.800.304.3064
Address:2826 South Potter Drive, Tempe, AZ 85282
Website
Phone:1.800.843.7477
Fax:1.800.418.4333
Phone:1.877.625.2566
Fax:1.888.752.7626
Phone:1.877.693.4376
Fax:1.512.693.4067
Website

Coding information

Hospital Inpatient Setting

Medicare Inpatient Coding and Payment (Part A)

This information details our general understanding of the application of certain codes to ANDEXXA. It is the provider’s sole responsibility to determine the appropriate codes for any action taken in billing. This information is not intended to be definitive or exhaustive, and Portola makes no warranties or guarantees as to the accuracy or appropriateness of this information. Before filing any claim, providers should verify these requirements with specific payers.

  • Only one Medicare Severity-Diagnosis Related Group (MS-DRG) is assigned to a patient for a particular hospital admission, and determined by ICD-10-CM diagnoses and procedure codes.
    • Patients who received ANDEXXA during their hospital stay may be assigned to different MS-DRGs based on these variables.
  • Effective Oct. 1, 2016, there are two unique ICD-10-PCS procedure codes that are applicable for the introduction of ANDEXXA.2
ICD-10-PCS Code Descriptor
XW03372
Introduction of Andexanet Alfa, Factor Xa Inhibitor Reversal Agent into Peripheral Vein, Percutaneous Approach, New Technology Group 2
XW04372
Introduction of Andexanet Alfa, Factor Xa Inhibitor Reversal Agent into Central Vein, Percutaneous Approach, New Technology Group 2
ANDEXXA (coagulation factor Xa (recombinant), inactivated-zhzo) is also referred to by the US adopted name (USAN) of andexanet alfa.

Medicare New Technology Add-on Payment (NTAP)

In addition to the MS-DRG payment, NTAP may facilitate an additional payment, equal to the lesser of (i) 65% of the cost of ANDEXXA being directly paid for in addition to the MS-DRG payment or (ii) 65% of the amount by which the costs of the case exceed the standard MS-DRG payment.

NTAP reimbursement for this product has been renewed until September 30, 2021.5

cms-logo

CMS has granted ANDEXXA an additional NTAP payment up to

$18,281.25

effective October 1, 20192‡

Eligibility to receive add-on payments may vary. Hospitals not reimbursed under the IPPS are not eligible to receive add-on payments.

Hospital Outpatient Setting

Standardized code for ANDEXXA insurance claims across Medicare, Medicare Advantage, Medicaid and commercial plans

Effective July 1, 2020, the Centers for Medicare and Medicaid Services (CMS) has granted ANDEXXA its permanent J-code, facilitating reimbursement in all hospital outpatient departments and freestanding emergency facilities in the United States.3

HCPCS Code Brand Name HCPCS Description
J7169
ANDEXXA
Injection, coagulation Factor Xa (recombinant), inactivated-zhzo (ANDEXXA), 10 mg
For services on or after July 1, 2020

For ANDEXXA claims for dates of service before July 1, 2020, hospitals must bill for ANDEXXA using its unique HCPCS C-code, C9041, to be eligible for pass-through payment. For payers who do not accept C-code claims before July 1, 2020, institutions may bill the miscellaneous J-code, J3590, for ANDEXXA.4

Because coding and billing requirements may vary, providers should check with payers directly to verify the information needed for claims submission.

References: 1. Andexxa (prescribing information). South San Francisco, CA: Portola Pharmaceuticals Inc. 2020. 2. Centers for Medicare & Medicaid Services (CMS). Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and policy changes and fiscal year 2020 rates; quality reporting requirements for specific providers; Medicare and Medicaid promoting interoperability programs requirements for eligible hospitals and critical access hospitals. Fed Regist. 2019;84(159):42044-42701. 3. Centers for Medicare & Medicaid Services (CMS). Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS) Application Summaries and Coding Decisions: First Quarter, 2020 Coding Cycle for Drug and Biological Products. https://www.cms.gov/files/document/2020-hcpcs-application-summary-quarter-1-2020-drugs-and-biologicals.pdf. Published Q1 2020. Accessed April 8, 2020. 4. Centers for Medicare & Medicaid Services (CMS). April 2019 update of the Hospital Outpatient Prospective Payment System (OPPS). https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4255CP.pdf. Accessed January 13, 2019. 5. CMS HHS Medicare Program Federal Register 2020 ONLINE