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Access DAXXIFY is here for your practice and patients

From billing and coding information to patient affordability programs, Access DAXXIFY simplifies the process for the entire practice.

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Access DAXXIFY and the information contained in this website is intended for informational purposes only and does not represent legal or billing advice. It is the responsibility of the provider and practice to ensure the accuracy of all information and claims that are submitted for reimbursement.

What is DAXXIFY®?

DAXXIFY® (daxibotulinumtoxinA-lanm) for injection is supplied as a sterile, preservative-free, white to off-white lyophilized powder in a single-dose vial for intramuscular use after reconstitution.

Each vial contains 100 Units of daxibotulinumtoxinA-lanm, L-histidine (0.14 mg), L-histidine-HCl monohydrate (0.65 mg), polysorbate 20 (0.1 mg), RTP004 peptide (11.7 mcg), and trehalose dihydrate (36 mg).

j-code J0589
10 digit ndc 72960-112-01
11 digit ndc 72960-0112-01
billing units 100 units
Note: Hyphens in NDC numbers are used only to illustrate the various formatting examples. Do not use hyphens when entering the NDC in your claim. For therapeutic use only.

Payer coverage and benefits investigation

DAXXIFY® is a physician administered, long-lasting neurotoxin.

Payers typically manage physician-administered products through the medical benefit and will create a medical policy that outlines specific coverage criteria.

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Benefits investigation

Completing a benefits investigation prior to treating a patient with DAXXIFY® is an important first step in determining key coverage criteria applicable to your patient’s individual health plan policy.

Once a benefit investigation is submitted, the Access DAXXIFY program will send the physician a summary of benefits for your patient.

Download and fax a benefits investigation Submit a benefits investigation online

Billing, coding, and modifiers

Appropriate billing and coding can help assure timely and adequate reimbursement.

The codes provided here are commonly associated with the administration of DAXXIFY®; however, providers should contact the patient’s health plan for specific guidance on coding and site of care requirements before administration.

Healthcare Common Procedure Coding System (HCPCS) Codes

Provider-administered drugs are typically reported with HCPCS Level II J-codes and assigned by CMS.

Code Description
J0589 Injection, daxibotulinumtoxinA-lanm, 1 unit [Daxxify®]

National Drug Codes (NDC)

NDCs are unique numbers that identify a drug's labeler, product, and trade package size.

10-Digit Code (5-3-2 format) 11-Digit Code (-5-4-2 format) Description
72960-112-01 72960-0112-01 DaxibotulinumtoxinA-lanm, 100 Units, single-dose vial
The FDA uses a 10-digit format when registering NDCs; however, payer requirements regarding use of a 10-digit or 11-digit NDC on claim forms varies. CMS requires an 11-digit NDC format. It is important to check with individual health plans before billing.

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Codes

ICD-10-CM is the diagnosis code set used for all healthcare settings for medical claims reporting.

ICD-10 code Description
G24.3 Spasmodic torticollis
M43.6 Torticollis
This information is for educational purposes only. The provider is ultimately responsible for determining the most appropriate ICD-10 code for billing. Please refer to the patient’s specific payer policy or ICD-10 coding handbook for further assistance.

Current Procedural Terminology (CPT®) Codes

CPT® is the code set used to describe procedures and services performed by healthcare providers.

CPT Code Description
64616 Chemodenervation of muscle(s); neck muscle(s), excluding muscles of the larynx, unilateral (eg, for cervical dystonia, spasmodic torticollis)
95873 Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure). Use in conjunction with 64612-64616 and 64642-64647
95874 Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure). Use in conjunction with 64612-64616 and 64642-64647
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation

Modifiers

Modifiers are 2-digit codes that are added to a CPT® or HCPCS code and used to provide additional information about an item or service provided.

Modifier Description
50 Bilateral (may use when injections occur on the right and left side. Requirements vary by plan)
LT Left Side
RT Right Side
JW Discarded drug not administered
JZ Zero drug wasted (effective July 1, 2023, Medicare plans will require the JZ Modifier to attest that there was no discarded amount from a single vial. Requirements vary by plan)
59 Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day

Place of Service (POS) Codes

POS codes are 2-digit numeric codes used to indicate the setting in which a healthcare service was provided.

POS Code Description
11 Office
19 Off-Campus Outpatient Hospital
22 Off-Campus Outpatient Hospital

Medical necessity and appeal resources

The following documents may be helpful during the medical necessity or appeals process

Daxxify Vial

Access DAXXIFY has options to support your patients

WARNING: DISTANT SPREAD OF TOXIN EFFECT
The effects of DAXXIFY® and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening and there have been reports of death. DAXXIFY® is not approved for the treatment of spasticity or any conditions other than cervical dystonia and glabellar lines.

INDICATION
DAXXIFY® (daxibotulinumtoxinA-lanm) injection is an acetylcholine release inhibitor and neuromuscular blocking agent indicated for the treatment of cervical dystonia in adults.

IMPORTANT SAFETY INFORMATION
Contraindications
DAXXIFY® contraindications include hypersensitivity to any botulinum toxin preparation or any of the components in the formulation and infection at the injection site(s).

Warnings and Precautions
Please refer to Boxed Warning for Distant Spread of Toxin Effect.

The potency units of DAXXIFY® are not interchangeable with preparations of other botulinum toxin products. Recommended dose and frequency of administration should not be exceeded. Patients should seek immediate medical attention if respiratory, speech or swallowing difficulties occur. Use caution when administering to patients with pre-existing cardiovascular disease. Concomitant neuromuscular disorders may exacerbate clinical effects of treatment.

Adverse Reactions
The most commonly observed adverse reactions (≥5%) were headache (9%), injection site pain (8%), injection site erythema (5%), muscular weakness (5%), and upper respiratory tract infection (5%).

Drug Interactions
Co-administration of DAXXIFY® and aminoglycoside antibiotics, anticholinergic agents or any other agents interfering with neuromuscular transmission or muscle relaxants should only be performed with caution as the effect of DAXXIFY® may be potentiated. The effect of administering different botulinum neurotoxins during course of treatment with DAXXIFY® is unknown.

Use in Specific Populations
DAXXIFY® is not recommended for use in children or pregnant women.

Please see DAXXIFY® full Prescribing Information, including Boxed Warning and Medication Guide.

To report side effects associated with DAXXIFY®, please visit safety.revance.com or call 1-877-373-8669. You may also report side effects to the FDA at 1-800-FDA-1088 or visit www.fda.gov/medwatch.

[DAXI-004725]

REFERENCES
1. DAXXIFY®. Prescribing Information. Revance Therapeutics, Inc; 2023. 2. Data on File. ASPEN CSR. Newark, CA: Revance Therapeutics, Inc, 2018. 3. Data on File. ASPEN OLS CSR. Newark, CA: Revance Therapeutics, Inc, 2018. 4. Centers for Medicare & Medicaid Services (CMS). Medicare Coverage Database. Local Coverage Determinations (LCD): Botulinum Toxin Type A & Type B. CMS website. Updated 2022. Accessed June 26, 2023. https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=34635. 5. Aetna Better Health. Pharmacy Prior Authorization. Clinical Guideline—Botulinum Toxins. Aetna Better Health website. Updated 2023. Accessed June 26, 2023. https://www.aetnabetterhealth.com/illinois/assets/pdf/botox.pdf. 6. BOTOX®. Prescribing Information. Allergan Inc; 2022. 7. XEOMIN®. Prescribing Information. Merz Pharmaceuticals GmbH; 2021. 8. DYSPORT®. Prescribing Information. Ipsen Biopharm Ltd; 2020. 9. JEUVEAU®. Prescribing Information. Evolus, Inc; 2020. 10. Myobloc®. Prescribing Information. Supernus® Pharmaceuticals; 2021 11. Data on File. Time to retreatment. Newark, CA: Revance Therapeutics, Inc, 2024