Access & Reimbursement

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Portola Access Navigator (PAN) is a suite of educational programs, remote reimbursement support, and onsite representatives to address your billing and coding needs for Andexxa.

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How to Order Andexxa

To order Andexxa, please contact one of our approved distributors:

One of the approved distributors for Andexxa is BioCare SD.

Phone: 1.800.304.3064

Address: 2826 South Potter Drive, Tempe, AZ 85282

https://www.biocaresd.com/

One of the approved distributors for Andexxa is Prodigy Health.

Phone: 1.877.693.4376

Fax: 1.512.693.4067

[email protected]

https://www.prodigyhealth.com/

How Andexxa Is Supplied

ANDEXXA vials are provided as follows:

Andexxa box and vial sitting side-by-side, with description of packaging configuration and order number

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.

Andexxa box and vial sitting side-by-side, with description of packaging configuration and order number

Reimbursement for Andexxa

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 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

ICD-10-PCS CodeDescriptor
XW03372Introduction of Andexanet Alfa, Factor Xa Inhibitor Reversal Agent into Peripheral Vein, Percutaneous Approach, New Technology Group 2
XW04372Introduction 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.

Andexxa (coagulation factor Xa (recombinant), inactivated-zhzo) is also referred to by the US adopted name (USAN) of andexanet alfa.

*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

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. 
HCPCS CodeC9041
For Services On or After July 1, 20201
Brand NameAndexxa
HCPCS DescriptionInjection, coagulation Factor Xa (recombinant), inactivated (andexxa), 10 mg
HCPCS CodeBrand NameHCPCS Description
For Services On or After July 1, 20201
J7169AndexxaInjection, coagulation Factor Xa (recombinant), inactivated-zhzo (Andexxa), 10 mg

1. 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.

The NDCs for Andexxa are:

10-Digit NDCAndexxa Package Size
69853-0101-14 single-use vials in a carton, each vial containing 100 mg of Andexxa
69853-0102-14 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.