On Jan. 1, 2025, the NOPAIN (Non-Opioids Prevent Addiction in the Nation) Act of December 2022 took effect. This new law directs CMS to make a “separate” payment under the Outpatient Proposed Payment System (OPPS) for certain non-opioid pain relief in the hospital outpatient department (OPD) setting only between Jan. 1, 2025 and Dec. 31, 2027. The new payments must be separate and in addition to the payment to the facility for the underlying procedure. Of five non-opioid pain drugs approved by CMS for separate payment in 2025 in the OPD setting, only two are approved for use with TJA:
- Exparel (C9290, injection, bupivacaine liposome, 1mg) for TKA & THA
- Zynrelef (C9088, instillation, bupivacaine and meloxicam, 1mg) for TKA & THA
On Oct. 9, 2024, as a part of the 2024 Q3 HCPCS Coding Cycle, CMS approved assignment of Exparel to new J-code J0666. For more details, read the summary.
