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Additional reimbursement available for Medicare patients

New technology add-on payment (NTAP) status granted for qualifying Medicare patients

ICD-10-PCS codes are: XW033H4 and XW043H4

Effective October 1, 2018 (Fiscal Year 2019)

Medicare has provided an add-on payment for GIAPREZA of up to $1500 per qualifying case to Inpatient Prospective Payment System (IPPS)–participating acute care hospitals.a This add-on payment will be incremental to the Medicare Severity Diagnosis–Related Group (MS–DRG) reimbursement for qualifying Medicare inpatient cases based on the cost of the case. Hospitals report the use of GIAPREZA by recording an ICD-10 procedure code (ICD-10-PCS code) on the claim billed to Medicare. These codes accompany the other ICD-10-PCS codes billed for the inpatient services.

What is the NTAP?

The NTAP was implemented to ensure access to new, clinically beneficial technologies to Medicare beneficiaries while the prospective payment system is recalibrated to reflect the cost of new technology. Centers for Medicare and Medicaid Services (CMS) reimburses hospitals up to 50% of the average cost related to the use of an eligible new technology, in addition to the prospective MS–DRG payment.

The NTAP is granted only to technologies that meet 3 primary criteria:

Highlights the NTAP approval and economic benefits.

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It must be:

Summary of NTAP details for GIAPREZAa

Eligible facilities IPPS-participating acute care hospitals
Setting of care IPPS inpatient hospital
Eligible patients Medicare-eligible patients
ICD-10 PCS-codesb,c XW043H4 Introduction of synthetic human angiotensin II into central vein
XW033H4 Introduction of synthetic human angiotensin II into peripheral vein*

*Administration via central line is recommended. GIAPREZA should NOT be administered in the same peripheral line as other vasopressors. Blood pressure should be closely monitored.

Hospitals not reimbursed under the IPPS, including but not limited to critical access hospitals, excluded cancer hospitals, long-term acute care hospitals, Veterans Affairs hospitals, Department of Defense facilities, and hospitals in the state of Maryland, are not eligible to receive add-on payments.

aThis information is subject to change, and providers should consult relevant references for the description of each code to determine its appropriateness. bThis list is not designed to be a comprehensive list of procedure codes for any given case. Other procedure codes may be appropriate and submitted to payers. Providers are solely responsible for determining the appropriate codes in billing payers. It is the provider’s responsibility to determine and submit appropriate codes, charges, and modifiers for the products and services rendered. cBefore filing any claim, providers should verify these requirements in writing with specific payers.

Important Safety Information See more

Warnings and Precautions The safety of GIAPREZA was evaluated in 321 adults with septic or other distributive shock in the randomized, double-blind, placebo-controlled ATHOS-3 study. There was a higher incidence of arterial and venous thrombotic and thromboembolic events in patients who received GIAPREZA compared to placebo treated patients in the ATHOS-3 study [13% (21/163 patients) vs. 5% (8/158 patients)]. The major imbalance was in deep venous thromboses. Use concurrent venous thromboembolism prophylaxis.

IndicationGIAPREZA™ (angiotensin II) increases blood pressure in adults with septic or other distributive shock.

Important Safety Information

Indication GIAPREZA™ (angiotensin II) increases blood pressure in adults with septic or other distributive shock.

Contraindications None.

Warnings and Precautions The safety of GIAPREZA was evaluated in 321 adults with septic or other distributive shock in the randomized, double-blind, placebo-controlled ATHOS-3 study. There was a higher incidence of arterial and venous thrombotic and thromboembolic events in patients who received GIAPREZA compared to placebo treated patients in the ATHOS-3 study [13% (21/163 patients) vs. 5% (8/158 patients)]. The major imbalance was in deep venous thromboses. Use concurrent venous thromboembolism prophylaxis.

Adverse Reactions The most common adverse reactions reported in greater than 10% of GIAPREZA-treated patients were thromboembolic events. Adverse reactions occurring in ≥4% of patients treated with GIAPREZA and ≥1.5% more often than placebo-treated patients in the ATHOS-3 study were thromboembolic events (including deep vein thrombosis), thrombocytopenia, tachycardia, fungal infection, delirium, acidosis, hyperglycemia, and peripheral ischemia.

Drug Interactions Angiotensin converting enzyme inhibitors may increase response to GIAPREZA.

Angiotensin II receptor blockers may reduce response to GIAPREZA.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

For additional Important Safety Information, please see the full Prescribing Information.

Reference: GIAPREZA™ (angiotensin II) [prescribing information]. San Diego, CA: La Jolla Pharmaceutical Company; 2017.