Hospitals may be granted an additional reimbursement of up to $1,750 by the CMS when PRAXBIND exceeds the Medicare Severity Diagnosis-Related Groups (MS-DRG) payment amount.
||Appropriate CPT codes for the drug administration:
|HCPCS||HCPCS codes are not typically used in this setting||
|Revenue||[025X]: Drugs and Biologics (to identify PRAXBIND)||
|Diagnosis||Appropriate ICD-10 code||Appropriate ICD-10 code|
The payment amount will be based on the hospital's costs for the inpatient stay, not on the dosage of PRAXBIND administered.
The charges reported by hospitals will affect the total costs of an inpatient stay, which Medicare uses to calculate NTAPs for eligible cases; therefore, it is important for hospitals to report charges for PRAXBIND at appropriate levels and report these charges whenever PRAXBIND is used.
When applicable, the additional payment will be calculated case by case. NTAP reimbursements for inpatient stays shall be limited to the lesser of:
*If the costs of a given case do not exceed the hospital's MS-DRG payment, additional payment for PRAXBIND will not be provided.
In order to receive separate payment for PRAXBIND within the outpatient setting, hospitals may bill using the below:
Praxbind® (idarucizumab) is indicated in patients treated with Pradaxa® when reversal of the anticoagulant effects of dabigatran is needed:
CL-PB-100001 April 2018
Please click here for full Prescribing Information for PRAXBIND.