Ordering & Billing Codes for
NEXPLANON® (etonogestrel implant) 68 mg Radiopaque
Select any of the topics below to jump to specific Ordering & Billing sections
How to get NEXPLANON
Options for obtaining NEXPLANON
NEXPLANON is covered by most health care plans. If covered, NEXPLANON will be covered as either a medical benefit or a pharmacy benefit.
Verify each patient’s insurance coverage
Insurance coverage varies from patient to patient. It is important to know what coverage the patient has before NEXPLANON is purchased.
Specialty distributors/buy and bill
This is the most common form of coverage for NEXPLANON. It means that both the drug and procedure are covered under the same benefit. A practice may purchase NEXPLANON from specialty distributors to maintain an in-office inventory.
These graphics denote a typical process for procurement. Procurement processes are subject to change. Contact your preferred procurement provider for a complete overview of the current procurement process.
1. Establish Account
Practice establishes an account with either CuraScript SD or TheraCom (specialty distributors)
2. Order Implant
Practice orders NEXPLANON
3. Benefit Investigation for Appropriate Patient
Once a patient and the HCP determine that NEXPLANON is appropriate, a benefit investigation is conducted either by the office or the Customer Support Center for NEXPLANON
4. Same-day Procedure Possible
If coverage is confirmed, the patient may receive NEXPLANON that day
5. Bill Insurance
Practice bills insurance carrier for procedure and implant
6. Payment
Practice pays invoice for NEXPLANON
Establish an account with one of our 2 specialty distributors
Ordering with CuraScript
You can order NEXPLANON by accessing a 90-day line of credit or using a credit card payment through your CuraScript SD account. Please check with the distributor for details and to confirm eligibility.
CURASCRIPT SD CALL CENTER
CuraScript SD has a dedicated team to support and assist you with online ordering for NEXPLANON.
Phone: 877-599-7748
Hours: Monday-Friday 8 AM-7 PM ET
Fax: 866-389-7928
Ordering with TheraCom
You can order NEXPLANON by accessing a 90-day line of credit or using a credit card payment. Please check with the distributor for details and to confirm eligibility.
THERACOM CALL CENTER
Phone: 866-318-3492
Hours: Monday-Friday 8 AM-8 PM ET
Fax: 866-769-3882
A 2% prompt pay discount is available under both the CuraScript SD and TheraCom specialty distributors for eligible customers.
Commercial Coverage Assurance Program for NEXPLANON
Rebate Request
This program is intended to help customers who are reimbursed less than their acquisition cost for NEXPLANON on eligible patient claims for dates of service between February 1, 2024, and October 31, 2024.
If your request meets all the criteria set forth below, you will receive a rebate check for the difference between (1) the total reimbursement amount you received for that unit from the plan and from patient cost sharing amounts and (2) the acquisition cost for NEXPLANON. The maximum amount of the rebate check is $200 per claim.
To request a rebate, you are required to submit the following documentation:
For any questions about the program, please call 800-561-5484 between 8 AM and 5 PM ET.
Additional program terms and conditions:
Specialty pharmacy
This is the less common form of coverage for NEXPLANON. It means that the drug is covered separately from the procedure.
After the pharmacy benefit is determined, a specialty pharmacy can deliver NEXPLANON to the practice.
These graphics denote a typical process for procurement. Procurement processes are subject to change. Contact your preferred procurement provider for a complete overview of the current procurement process.
1. Benefit Investigation for Appropriate Patient
Once a patient and the HCP determine that NEXPLANON is appropriate, office submits the NEXPLANON enrollment form to the Customer Support Center (via fax or patient portal) to determine coverage. The enrollment form also serves as a prescription
2. Specialty Pharmacy Selection
If insurance plan allows for a pharmacy benefit option, prescription is triaged to the appropriate specialty pharmacy preferred by that plan
3. Bill Insurance for Implant
Specialty pharmacy will bill insurance plan for NEXPLANON and will ship patient-specific NEXPLANON to the office
4. Schedule Patient
Office schedules patient for procedure
5. Procedure
Patient returns to office for procedure
6. Bill Insurance for Procedure
Once procedure takes place, practice bills insurance carrier for procedure
Our specialty pharmacy network
Accredo Pharmacy
866-844-0148
CVS Specialty Pharmacy
800-237-2767
AllianceRx Walgreens Pharmacy
888-380-6188
CenterWell Pharmacy
800-486-2668
ASPN Pharmacies, LLC
888-970-0195
Magellan Rx Pharmacy
866-554-2673
The Customer Support Center for NEXPLANON (CSCN)
CSCN may be able to help answer questions about:
How to enroll
You can fill out and submit the form using our online portal
There is also the option to download, print, complete, and fax the form
Additional resources
Phone: 844-NEX-4321 (844-639-4321) or Fax: 844-232-2618
Possible billing codes
To accurately bill and obtain reimbursement, it’s important for you to know which billing codes to use to describe NEXPLANON and any procedures related to it.
The codes listed below may be relevant when billing for NEXPLANON and its insertion or removal. The information available here is compiled from sources believed to be accurate, but Organon makes no representation that it is accurate. This information is subject to change. Payer coding requirements may vary or change over time, so it is important to regularly check with each payer as to payer-specific requirements.
The information available here is not intended to be conclusive or exhaustive, and is not intended to replace the guidance of a qualified professional advisor. Organon and its agents make no warranties or guarantees, expressed or implied, concerning the accuracy or appropriateness of this information for your particular use given the frequent changes in public and private payer billing. The use of this information does not guarantee payment or that any payment received will cover your costs.
You are solely responsible for determining the appropriate codes and for any action you take in billing. Diagnosis codes should be selected only by a health care professional, and should appropriately reflect the diagnosis, the services rendered, and the applicable payer’s guidelines.
Consult the relevant manual and other guidelines for a description of each code to determine the appropriateness of a particular code and for information on additional codes.
Billing codes
Please note: Other codes may also be appropriate for NEXPLANON; consult the ICD-10-CM Manual to check the appropriateness of a particular code and for information on additional codes.
Definitions
CPT = Current Procedural Terminology. CPT Copyright 2017 American Medical Association. All rights reserved.
CPT® is a registered trademark of the American Medical Association. CPT 2018 Professional Edition. Chicago, Ill: American Medical Association, 2017.
ICD-10 = International Classification of Diseases, Tenth Revision, Clinical Modification. National Center for Health Statistics, Centers for Disease Control and Prevention. FY 2018 ICD-10-CM. Available at: https://www.cdc.gov/nchs/icd/icd-10-cm.htm.
J-code = J-codes are part of the Healthcare Common Procedure Coding System (HCPCS). Centers for Medicare and Medicaid Services. 2018 Alpha-Numeric HCPCS File. Available at: https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS-Items/2018-Alpha-Numeric-HCPCS-File-.html.
CSCN = Customer Support Center for NEXPLANON; HCP = healthcare professional; NDC = National Drug Code.
NEXPLANON is indicated for use by women to prevent pregnancy.
Complications of Insertion and Removal
Broken or Bent Implants
Changes in Menstrual Bleeding Patterns
Ectopic Pregnancies
Thrombotic and Other Vascular Events
Ovarian Cysts
Carcinoma of the Breast and Reproductive Organs
Liver Disease
Elevated Blood Pressure
Gallbladder Disease
Carbohydrate and Lipid Metabolic Effects
Depressed Mood
Return to Ovulation
Fluid Retention
Contact Lenses
Clinical Trial Experience
Effects of Other Drugs on Hormonal Contraceptives
Substances decreasing the plasma concentrations of hormonal contraceptives and potentially diminishing the efficacy of hormonal contraceptives:
Substances increasing the plasma concentrations of hormonal contraceptives:
Human Immunodeficiency Virus (HIV)/Hepatitis C Virus (HCV) protease inhibitors and non-nucleoside reverse transcriptase inhibitors:
Effects of Hormonal Contraceptives on Other Drugs
USE IN SPECIFIC POPULATIONS
Pregnancy
Lactation
Pediatric Use
Overweight Women
Before prescribing NEXPLANON, please read the accompanying Prescribing Information. The Patient Information also is available.