Ordering & Reimbursement
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ANDEXXA vials are
provided as follows:
Carton NDC Number: 69853-0101-1
Carton Configuration: 4 single use vials in a carton, each vial containing 100 mg of ANDEXXA
Vial Cap Color: Vials have a blue flip-off cap
Packaging Color: Carton and vial label have a red colored stripe across the front. Carton and vial label have "100mg/vial" in a red graphic on the front panel.
Carton NDC Number: 69853-0102-1
Carton Configuration: 4 single use vials in a carton, each vial containing 200 mg of ANDEXXA
Vial Cap Color: Vials have a red flip-off cap
Packaging Color: Carton and vial label have a red to blue transition colored stripe across the front. Carton and label have "200mg/vial" in a blue graphic on the front panel.
Carton NDC Number:
69853-0102-1
Carton Configuration:
4 single use vials in a carton, each vial containing 200 mg of ANDEXXA
Vial Cap Color:
Vials have a red flip-off cap
Packaging Color:
Carton and vial label have a red to blue transition colored stripe across the front. Carton and label have "200mg/vial" in a blue graphic on the front panel.
 
Medicare New Technology Add-On Payment (NTAP)*
 
CMS has granted
ANDEXXA additional
NTAP payment up to
$18,281.25
effective October 1, 2019
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.

Other Reimbursement Considerations: 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 any applicable coverage requirements.
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 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.
  • It is important to use one of the two unique ICD-10-PCS procedure codes that were created effective October 1, 2016 for the introduction of Andexxa:
 
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.
ICD-10-PCS Codes and Descriptors*†
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.
Hospital Outpatient Setting
Medicare (Part B) Coding for Andexxa
  • Effective April 1, 2019, the Centers for Medicare and Medicaid Services (CMS) has granted Andexxa transitional pass-through status under a unique C-code.
 
HCPCS Code   Brand Name HCPCS Description
For Services On or After April 1, 2019      
C9041   Andexxa Injection, coagulation Factor Xa (recombinant), inactivated (andexxa), 10 mg
HCPCS Code C9041
For Services On or After April 1, 2019  
Brand Name Andexxa
HCPCS Description Injection, coagulation Factor Xa (recombinant), inactivated (andexxa), 10 mg
*Hospitals not reimbursed under the IPPS, including but not limited to critical access hospitals, excluded cancer hospitals, long-term acute care hospitals, Veterans Affairs (VA) hospitals, Department of Defense (DoD) facilities, and hospitals in the state of Maryland, are not eligible to receive add-on payments.
Hospital Outpatient Setting
Non-Medicare Coding for Andexxa
  • Non-Medicare payers may not recognize C-codes and therefore may require billing for Andexxa with a miscellaneous J-code instead:
 
HCPCS Code HCPCS Description
J3590 Unclassified biologics
HCPCS Code J3590
HCPCS Description Unclassified biologics
For claims with a miscellaneous J-code, payers may require the submission of additional information and/or documentation, such as:
  • Name of drug
  • Route of administration
  • Amount used in treatment
  • Invoice of drug purchase
  • National Drug Code(s) (NDC)
The NDCs for Andexxa are:
 
10-Digit NDC Andexxa Package Size  
69853-0101-1 4 single-use vials in a carton, each vial containing 100 mg of Andexxa  
69853-0102-1 4 single-use vials in a carton, each vial containing 200 mg of Andexxa  
Medicaid and some commercial payers may require conversion of 10-digit NDCs to 11-digit NDCs for claims submission by adding a zero to the beginning or the middle section of the NDC. Providers are responsible for verifying formatting requirements related to entry of NDCs on claims with payers.

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