Bristol-Myers Squibb is committed to helping appropriate patients get access to our medications by providing access and reimbursement support services.

This information is intended for U.S. healthcare professionals and/or healthcare professionals involved in healthcare reimbursement.

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Diagnosis Codes

Reimbursement and Coding Guide for OPDIVO

FDA Approval Letter as Posted by the FDA:

FDA Approval Letter as Posted by the FDA:

FDA Letter — For patients with metastatic melanoma

FDA Letter — For the adjuvant treatment of melanoma

FDA Letter — Flat Dosing for OPDIVO

FDA Approval Letter as Posted by the FDA:

FDA Letter — For adult patients with relapsed or progressed classical Hodgkin Lymphoma after autologous hematopoietic stem cell transplantation (HSCT) and brentuximab vedotin, or after 3 or more lines of systemic therapy that includes auto-HSCT

FDA Approval Letter as Posted by the FDA:

FDA Letter — For adult patients with previously treated locally advanced or metastatic urothelial carcinoma

FDA Approval Letters as Posted by the FDA:

Metastatic NSCLC:

FDA Letter — For patients with metastatic squamous NSCLC who have progression on or after platinum-based chemotherapy*

FDA Letter — For patients with metastatic non-squamous NSCLC who have progression on or after platinum-based chemotherapy*

FDA Letter — Flat Dosing for OPDIVO in mNSCLC

SCLC:

FDA Letter — For patients with metastatic SCLC with progression after platinum-based therapy and ≥1 additional line of therapy

*Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving OPDIVO.

FDA Approval Letters as Posted by the FDA:

FDA Approval Letter as Posted by the FDA:

FDA Letter — For patients with recurrent or metastatic squamous cell carcinoma of the head and neck with disease progression on or after platinum-based therapy

FDA Approval Letter as Posted by the FDA:

FDA Letter — OPDIVO for patients 12 years and older with MSI-H/dMMR metastatic colorectal cancer that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan

FDA Letter — OPDIVO in combination with YERVOY® (ipilimumab) for adults and pediatric patients 12 years and older with MSI-H/dMMR metastatic colorectal cancer that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan

Please see Important Safety Information and U.S. Full Prescribing Information for YERVOY, including Boxed WARNING regarding immune-mediated adverse reactions.

FDA Letter — For patients with hepatocellular carcinoma who have been previously treated with sorafenib

FDA Approval Letters as Posted by the FDA:

OPDIVO in combination with YERVOY® (ipilimumab) for the first-line treatment of patients with intermediate or poor risk, previously untreated advanced RCC

Please see Important Safety Information and U.S. Full Prescribing Information for YERVOY, including Boxed WARNING regarding immune-mediated adverse reactions.

FDA Letter — OPDIVO in combination with YERVOY for the treatment of patients with intermediate or poor-risk, previously untreated advanced RCC

OPDIVO for the treatment of patients with advanced renal cell carcinoma (RCC) who have received prior anti-angiogenic therapy

FDA Letter — For patients with advanced renal cell carcinoma (RCC) who received prior anti-angiogenic therapy

FDA Letter — Flat Dosing for OPDIVO (240 mg every 2 weeks)

FDA Letter — Flat Dosing for OPDIVO (480 mg every 4 weeks)

The information below is designed to help appropriate patients get access to OPDIVO by providing helpful reimbursement information for healthcare offices. It is important that offices verify each patient’s insurance coverage prior to initiating therapy. BMS Access Support may be able to help.

  • Codes
  • Distribution
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Type a keyword to find a specific HCPCS, CPT, NDC or ICD-10 code
Healthcare Common Procedure Coding System (HCPCS) Codes1 Issued by CMS
OPDIVO
J9299

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Injection, nivolumab, 1 mg

Effective January 1, 2017, providers and suppliers are required to report the JW modifier on Part B drug claims for discarded drugs and biologicals. Also, providers and suppliers must document the amount of discarded drugs or biologicals in Medicare beneficiaries’ medical records.2

YERVOY (ipilimumab)

For the first-line use in combination with OPDIVO for the treatment of patients with intermediate or poor-risk, previously untreated advanced RCC

J9228

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Injection, ipilimumab, 1 mg

Effective January 1, 2017, providers and suppliers are required to report the JW modifier on Part B drug claims for discarded drugs and biologicals. Also, providers and suppliers must document the amount of discarded drugs or biologicals in Medicare beneficiaries’ medical records.2

OPDIVO
J9299

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Injection, nivolumab, 1 mg

Providers and suppliers are required to report the JW modifier on Part B drug claims for discarded drugs and biologicals. Also, providers and suppliers must document the amount of discarded drugs or biologicals in Medicare beneficiaries’ medical records.2

YERVOY (ipilimumab)

For the third-line use in combination with OPDIVO for the treatment of adults and pediatric patients 12 years and older with microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) metastatic colorectal cancer (CRC) that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan

J9228

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Injection, ipilimumab, 1 mg

Providers and suppliers are required to report the JW modifier on Part B drug claims for discarded drugs and biologicals. Also, providers and suppliers must document the amount of discarded drugs or biologicals in Medicare beneficiaries' medical records.2

Revenue Codes (for Use in the Hospital Outpatient Setting)3
0636

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Drugs requiring detailed coding

0335

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Chemotherapy administration, IV

0260

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IV solutions

MSI/MMR CPT Testing Codes4
88342

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Immunohisto
chemistry or immunocyto
chemistry, per specimen; initial single antibody stain procedure

+88341

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Each additional single antibody stain procedure

81301

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Microsatellite instability analysis

Current Procedural Terminology (CPT)4,†
OPDIVO
96413

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Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug

YERVOY

For the first-line use in combination with OPDIVO for the treatment of patients with intermediate or poor-risk, previously untreated advanced RCC

96417

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Chemotherapy administration, IV infusion; each additional sequential infusion (different substance/drug), up to 1 hour (list separately in addition to code for primary procedure). (Use 96417 in conjunction with 96413)

96415

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Chemotherapy administration, IFV infusion; each additional hour (list separately in addition to code for primary procedure). (Report 96415 for infusion intervals of greater than 30 minutes beyond 1-hour increments)

OPDIVO
96413

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Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug

YERVOY

For the third-line use in combination with OPDIVO for the treatment of adults and pediatric patients 12 years and older with microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) metastatic colorectal cancer (CRC) that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan

96417

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Chemotherapy administration, IV infusion; each additional sequential infusion (different substance/drug), up to 1 hour (list separately in addition to code for primary procedure). (Use 96417 in conjunction with 96413)

96415

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Chemotherapy administration, IFV infusion; each additional hour (list separately in addition to code for primary procedure). (Report 96415 for infusion intervals of greater than 30 minutes beyond 1-hour increments)

MSI/MMR CPT Testing Codes4
88342

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Immunohisto
chemistry or immunocyto
chemistry, per specimen; initial single antibody stain procedure

+88341

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Each additional single antibody stain procedure

81301

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Microsatellite instability analysis

National Drug Codes (NDC)5 Issued by the FDA

Note:Payers require the submission of the 11-digit NDC on healthcare claim forms. Please use the 11-digit codes shown here.

OPDIVO
00003-3772-11

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40 mg/4 mL (10 mg/mL) single-dose vial

00003-3774-12

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100 mg/10 mL (10 mg/mL) single-dose vial

00003-3734-13

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240 mg/24 mL (10 mg/mL) single-dose vial

YERVOY

For the first-line use in combination with OPDIVO for the treatment of patients with intermediate or poor-risk, previously untreated advanced RCC

00003-2327-11

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One 50-mg vial (5 mg/mL), single-use vial

00003-2328-22

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One 200-mg vial (5 mg/mL), single-use vial

YERVOY

For the third-line use in combination with OPDIVO for the treatment of adults and pediatric patients 12 years and older with microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) metastatic colorectal cancer (CRC) that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan

00003-2327-11

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One 50-mg vial (5 mg/mL), single-use vial

00003-2328-22

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One 200-mg vial (5 mg/mL), single-use vial

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C43

Malignant melanoma of skin

C43.0

Malignant melanoma of lip

C43.1

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Malignant melanoma of eyelid, including canthus

C43.10

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Malignant melanoma of unspecified eyelid, including canthus

C43.11

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Malignant melanoma of right eyelid, including canthus

C43.12

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Malignant melanoma of left eyelid, including canthus

C43.2

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Malignant melanoma of ear and external auricular canal

C43.20

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Malignant melanoma of unspecified ear and external auricular canal

C43.21

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Malignant melanoma of right ear and external auricular canal

C43.22

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Malignant melanoma of left ear and external auricular canal

C43.3

Malignant melanoma of other and unspecified parts of face

C43.30

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Malignant melanoma of unspecified part of face

C43.31

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Malignant melanoma of nose

C43.39

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Malignant melanoma of other parts of face

C43.4

COPY

Malignant melanoma of scalp and neck

C43.5

COPY

Malignant melanoma of trunk

C43.51

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Malignant melanoma of anal skin

C43.52

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Malignant melanoma of skin of breast

C43.59

Malignant melanoma of other part of trunk

C43.6

Malignant melanoma of upper limb, including shoulder

C43.60

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Malignant melanoma of unspecified upper limb, including shoulder

C43.61

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Malignant melanoma of right upper limb, including shoulder

C43.62

Malignant melanoma of left upper limb, including shoulder

C43.7

COPY

Malignant melanoma of lower limb, including hip

C43.70

COPY

Malignant melanoma of unspecified lower limb, including hip

C43.71

COPY

Malignant melanoma of right lower limb, including hip

C43.72

COPY

Malignant melanoma of left lower limb, including hip

C43.8

COPY

Malignant melanoma of overlapping sites of skin

C43.9

COPY

Malignant melanoma of skin, unspecified

C21

COPY

Malignant neoplasm of anus and anal canal

C21.0

Malignant neoplasm of anus, unspecified

C21.1

Malignant neoplasm of anal canal

C51

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Malignant neoplasm of vulva

C51.0

COPY

Malignant neoplasm of labium majus

C51.1

COPY

Malignant neoplasm of labium minus

C51.2

COPY

Malignant neoplasm of clitoris

C51.9

Malignant neoplasm of vulva, unspecified

C52

COPY

Malignant neoplasm of vagina

C57

COPY

Malignant neoplasm of other and unspecified female genital organs

C57.7

Malignant neoplasm of other specified female genital organs

C57.8

Malignant neoplasm of overlapping sites of female genital organs

C57.9

COPY

Malignant neoplasm of female genital organ, unspecified

C60

COPY

Malignant neoplasm of penis

C60.0

COPY

Malignant neoplasm of prepuce

C60.1

Malignant neoplasm of glans penis

C60.8

Malignant neoplasm of overlapping sites of penis

C60.9

COPY

Malignant neoplasm of penis, unspecified

C63

Malignant neoplasm of other and unspecified male genital organs

C63.0

Malignant neoplasm of epididymis

C63.00

Malignant neoplasm of unspecified epididymis

C63.01

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Malignant neoplasm of right epididymis

C63.02

Malignant neoplasm of left epididymis

C63.1

Malignant melanoma of spermatic cord

C63.10

Malignant neoplasm of unspecified spermatic cord

C63.11

Malignant neoplasm of right spermatic cord

C63.12

Malignant neoplasm of left spermatic cord

C63.2

Malignant neoplasm of scrotum

C63.7

Malignant neoplasm of other specified male genital organs

C63.8

Malignant neoplasm of overlapping sites of male genital organs

C63.9

Malignant neoplasm of male genital organ, unspecified

Z51.12

Encounter for antineoplastic immunotherapy

If infusion for antineoplastic immunotherapy is the only reason for the patient encounter, physicians and hospitals may report ICD-10-CM code “Z51.12 Encounter for antineoplastic immunotherapy” as the primary diagnosis.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)7

C64

Malignant neoplasm of kidney, except renal pelvis

C64.1

Malignant neoplasm of right kidney, except renal pelvis

C64.2

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Malignant neoplasm of left kidney, except renal pelvis

C64.9

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Malignant neoplasm of unspecified kidney, except renal pelvis

C65

COPY

Malignant neoplasm of renal pelvis

C65.1

COPY

Malignant neoplasm of right renal pelvis

C65.2

COPY

Malignant neoplasm of left renal pelvis

C65.9

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Malignant neoplasm of unspecified renal pelvis

Z51.12

Encounter for antineoplastic immunotherapy
If infusion for antineoplastic immunotherapy is the only reason for the patient encounter, physicians and hospitals may report ICD-10-CM code “Z51.12 Encounter for antineoplastic immunotherapy” as the primary diagnosis.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C81

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Hodgkin lymphoma

C81.1

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Nodular sclerosis Hodgkin lymphoma

C81.10

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Nodular sclerosis Hodgkin lymphoma, unspecified site

C81.11

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Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck

C81.12

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Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes

C81.13

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Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes

C81.14

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Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb

C81.15

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Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb

C81.16

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Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes

C81.17

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Nodular sclerosis Hodgkin lymphoma, spleen

C81.18

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Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites

C81.19

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Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites

C81.2

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Mixed cellularity Hodgkin lymphoma

C81.20

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Mixed cellularity Hodgkin lymphoma, unspecified site

C81.21

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Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck

C81.22

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Mixed cellularity Hodgkin lymphoma, intrathoracic lymph nodes

C81.23

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Mixed cellularity Hodgkin lymphoma, intra-abdominal lymph nodes

C81.24

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Mixed cellularity Hodgkin lymphoma, lymph nodes of axilla and upper limb

C81.25

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Mixed cellularity Hodgkin lymphoma, lymph nodes of inguinal region and lower limb

C81.26

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Mixed cellularity Hodgkin lymphoma, intrapelvic lymph nodes

C81.27

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Mixed cellularity Hodgkin lymphoma, spleen

C81.28

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Mixed cellularity Hodgkin lymphoma, lymph nodes of multiple sites

C81.29

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Mixed cellularity Hodgkin lymphoma, extranodal and solid organ sites

C81.3

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Lymphocyte-depleted Hodgkin lymphoma

C81.30

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Lymphocyte-depleted Hodgkin lymphoma, unspecified site

C81.31

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Lymphocyte-depleted Hodgkin lymphoma, lymph nodes of head, face, and neck

C81.32

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Lymphocyte-depleted Hodgkin lymphoma, intrathoracic lymph nodes

C81.33

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Lymphocyte-depleted Hodgkin lymphoma, intra-abdominal lymph nodes

C81.34

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Lymphocyte-depleted Hodgkin lymphoma, lymph nodes of axilla and upper limb

C81.35

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Lymphocyte-depleted Hodgkin lymphoma, lymph nodes of inguinal region and lower limb

C81.36

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Lymphocyte-depleted Hodgkin lymphoma, intrapelvic lymph nodes

C81.37

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Lymphocyte-depleted Hodgkin lymphoma, spleen

C81.38

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Lymphocyte-depleted Hodgkin lymphoma, lymph nodes of multiple sites

C81.39

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Lymphocyte-depleted Hodgkin lymphoma, extranodal and solid organ sites

C81.4

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Lymphocyte-rich Hodgkin lymphoma

C81.40

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Lymphocyte-rich Hodgkin lymphoma, unspecified site

C81.41

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Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck

C81.42

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Lymphocyte-rich Hodgkin lymphoma, intrathoracic lymph nodes

C81.43

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Lymphocyte-rich Hodgkin lymphoma, intra-abdominal lymph nodes

C81.44

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Lymphocyte-rich Hodgkin lymphoma, lymph nodes of axilla and upper limb

C81.45

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Lymphocyte-rich Hodgkin lymphoma, lymph nodes of inguinal region and lower limb

C81.46

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Lymphocyte-rich Hodgkin lymphoma, intrapelvic lymph nodes

C81.47

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Lymphocyte-rich Hodgkin lymphoma, spleen

C81.48

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Lymphocyte-rich Hodgkin lymphoma, lymph nodes of multiple sites

C81.49

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Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites

C81.7

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Other Hodgkin lymphoma

C81.70

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Other Hodgkin lymphoma, unspecified site

C81.71

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Other Hodgkin lymphoma, lymph nodes of head, face, and neck

C81.72

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Other Hodgkin lymphoma, intrathoracic lymph nodes

C81.73

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Other Hodgkin lymphoma, intra-abdominal lymph nodes

C81.74

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Other Hodgkin lymphoma, lymph nodes of axilla and upper limb

C81.75

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Other Hodgkin lymphoma, lymph nodes of inguinal region and lower limb

C81.76

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Other Hodgkin lymphoma, intrapelvic lymph nodes

C81.77

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Other Hodgkin lymphoma, spleen

C81.78

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Other Hodgkin lymphoma, lymph nodes of multiple sites

C81.79

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Other Hodgkin lymphoma, extranodal and solid organ sites

Z51.12

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Encounter for antineoplastic immunotherapy

If infusion for antineoplastic immunotherapy is the only reason for the patient encounter, physicians and hospitals may report ICD-10-CM code “Z51.12 Encounter for antineoplastic immunotherapy” as the primary diagnosis.

Z94.84

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Stem cell transplant status

For patients who have had a stem cell transplant, add "Z94.84" as a secondary code

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C43

COPY

Malignant melanoma of skin

C43.0

COPY

Malignant melanoma of lip

C43.1

COPY

Malignant melanoma of eyelid, including canthus

C43.10

COPY

Malignant melanoma of unspecified eyelid, including canthus

C43.11

COPY

Malignant melanoma of right eyelid, including canthus

C43.12

COPY

Malignant melanoma of left eyelid, including canthus

C43.2

COPY

Malignant melanoma of ear and external auricular canal

C43.20

COPY

Malignant melanoma of unspecified ear and external auricular canal

C43.21

COPY

Malignant melanoma of right ear and external auricular canal

C43.22

COPY

Malignant melanoma of left ear and external auricular canal

C43.3

COPY

Malignant melanoma of other and unspecified parts of face

C43.30

COPY

Malignant melanoma of unspecified part of face

C43.31

COPY

Malignant melanoma of nose

C43.39

COPY

Malignant melanoma of other parts of face

C43.4

COPY

Malignant melanoma of scalp and neck

C43.5

COPY

Malignant melanoma of trunk

C43.51

COPY

Malignant melanoma of anal skin

C43.52

COPY

Malignant melanoma of skin of breast

C43.59

COPY

Malignant melanoma of other part of trunk

C43.6

COPY

Malignant melanoma of upper limb, including shoulder

C43.60

COPY

Malignant melanoma of unspecified upper limb, including shoulder

C43.61

COPY

Malignant melanoma of right upper limb, including shoulder

C43.62

COPY

Malignant melanoma of left upper limb, including shoulder

C43.7

COPY

Malignant melanoma of lower limb, including hip

C43.70

COPY

Malignant melanoma of unspecified lower limb, including hip

C43.71

COPY

Malignant melanoma of right lower limb, including hip

C43.72

COPY

Malignant melanoma of left lower limb, including hip

C43.8

COPY

Malignant melanoma of overlapping sites of skin

C43.9

COPY

Malignant melanoma of skin, unspecified

C21

COPY

Malignant neoplasm of anus and anal canal

C21.0

COPY

Malignant neoplasm of anus, unspecified

C21.1

COPY

Malignant neoplasm of anal canal

C51

COPY

Malignant neoplasm of vulva

C51.0

COPY

Malignant neoplasm of labium majus

C51.1

COPY

Malignant neoplasm of labium minus

C51.2

COPY

Malignant neoplasm of clitoris

C51.9

COPY

Malignant neoplasm of vulva, unspecified

C52

COPY

Malignant neoplasm of vagina

C57

COPY

Malignant neoplasm of other and unspecified female genital organs

C57.7

COPY

Malignant neoplasm of other specified female genital organs

C57.8

COPY

Malignant neoplasm of overlapping sites of female genital organs

C57.9

COPY

Malignant neoplasm of female genital organ, unspecified

C60

COPY

Malignant neoplasm of penis

C60.0

COPY

Malignant neoplasm of prepuce

C60.1

COPY

Malignant neoplasm of glans penis

C60.8

COPY

Malignant neoplasm of overlapping sites of penis

C60.9

COPY

Malignant neoplasm of penis, unspecified

C63

COPY

Malignant neoplasm of other and unspecified male genital organs

C63.0

COPY

Malignant neoplasm of epididymis

C63.00

COPY

Malignant neoplasm of unspecified epididymis

C63.01

COPY

Malignant neoplasm of right epididymis

C63.02

COPY

Malignant neoplasm of left epididymis

C63.1

COPY

Malignant melanoma of spermatic cord

C63.10

COPY

Malignant neoplasm of unspecified spermatic cord

C63.11

COPY

Malignant neoplasm of right spermatic cord

C63.12

COPY

Malignant neoplasm of left spermatic cord

C63.2

COPY

Malignant neoplasm of scrotum

C63.7

COPY

Malignant neoplasm of other specified male genital organs

C63.8

COPY

Malignant neoplasm of overlapping sites of male genital organs

C63.9

COPY

Malignant neoplasm of male genital organ, unspecified

Z51.12

COPY

Encounter for antineoplastic immunotherapy

If infusion for antineoplastic immunotherapy is the only reason for the patient encounter, physicians and hospitals may report ICD-10-CM code “Z51.12 Encounter for antineoplastic immunotherapy” as the primary diagnosis.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C00

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Malignant neoplasm of lip

C00.0

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Malignant neoplasm of external upper lip

C00.1

COPY

Malignant neoplasm of external lower lip

C00.2

COPY

Malignant neoplasm of external lip, unspecified

C00.3

COPY

Malignant neoplasm of upper lip, inner aspect

C00.4

COPY

Malignant neoplasm of lower lip, inner aspect

C00.5

COPY

Malignant neoplasm of lip, unspecified, inner aspect

C00.6

COPY

Malignant neoplasm of commissure of lip, unspecified

C00.8

COPY

Malignant neoplasm of overlapping sites of lip

C00.9

COPY

Malignant neoplasm of lip, unspecified

C01

COPY

Malignant neoplasm of base of tongue

C02

COPY

Malignant neoplasm of other and unspecified parts of tongue

C02.0

COPY

Malignant neoplasm of dorsal surface of tongue

C02.1

COPY

Malignant neoplasm of border of tongue

C02.2

COPY

Malignant neoplasm of ventral surface of tongue

C02.3

COPY

Malignant neoplasm of anterior two-thirds of tongue, part unspecified

C02.4

COPY

Malignant neoplasm of lingual tonsil

C02.8

COPY

Malignant neoplasm of overlapping sites of tongue

C02.9

COPY

Malignant neoplasm of tongue, unspecified

C03

COPY

Malignant neoplasm of gum

C03.0

COPY

Malignant neoplasm of upper gum

C03.1

COPY

Malignant neoplasm of lower gum

C03.9

COPY

Malignant neoplasm of gum, unspecified

C04

COPY

Malignant neoplasm of floor of mouth

C04.0

COPY

Malignant neoplasm of anterior floor of mouth

C04.1

COPY

Malignant neoplasm of lateral floor of mouth

C04.8

COPY

Malignant neoplasm of overlapping sites of floor of mouth

C04.9

COPY

Malignant neoplasm of floor of mouth, unspecified

C05

COPY

Malignant neoplasm of palate

C05.0

COPY

Malignant neoplasm of hard palate

C05.1

COPY

Malignant neoplasm of soft palate

C05.2

COPY

Malignant neoplasm of uvula

C05.8

COPY

Malignant neoplasm of overlapping sites of palate

C05.9

COPY

Malignant neoplasm of palate, unspecified

C06

COPY

Malignant neoplasm of other and unspecified parts of mouth

C06.0

COPY

Malignant neoplasm of cheek mucosa

C06.1

COPY

Malignant neoplasm of vestibule of mouth

C06.2

COPY

Malignant neoplasm of retromolar area

C06.8

COPY

Malignant neoplasm of overlapping sites of other and unspecified parts of mouth

C06.80

COPY

Malignant neoplasm of overlapping sites of unspecified parts of mouth

C06.89

COPY

Malignant neoplasm of overlapping sites of other parts of mouth

C06.9

COPY

Malignant neoplasm of mouth, unspecified

C09

COPY

Malignant neoplasm of tonsil

C09.0

COPY

Malignant neoplasm of tonsillar fossa

C09.1

COPY

Malignant neoplasm of tonsillar pillar (anterior) (posterior)

C09.8

COPY

Malignant neoplasm of overlapping sites of tonsil

C09.9

COPY

Malignant neoplasm of tonsil, unspecified

C10

COPY

Malignant neoplasm of oropharynx

C10.0

COPY

Malignant neoplasm of vallecula

C10.1

COPY

Malignant neoplasm of anterior surface of epiglottis

C10.2

COPY

Malignant neoplasm of lateral wall of oropharynx

C10.3

COPY

Malignant neoplasm of posterior wall of oropharynx

C10.4

COPY

Malignant neoplasm of branchial cleft

C10.8

COPY

Malignant neoplasm of overlapping sites of oropharynx

C10.9

COPY

Malignant neoplasm of oropharynx, unspecified

C12

COPY

Malignant neoplasm of pyriform sinus

C13

COPY

Malignant neoplasm of hypopharynx

C13.0

COPY

Malignant neoplasm of postcricoid region

C13.1

COPY

Malignant neoplasm aryepiglottic fold, hypopharyngeal aspect

C13.2

COPY

Malignant neoplasm of posterior wall of hypopharynx

C13.8

COPY

Malignant neoplasm of overlapping sites of hypopharynx

C13.9

COPY

Malignant neoplasm of hypopharynx, unspecified

C14

COPY

Malignant neoplasm of other and ill-defined sites in the lip, oral cavity and pharynx

C14.0

COPY

Malignant neoplasm of pharynx, unspecified

C14.2

COPY

Malignant neoplasm of Waldeyer’s ring

C14.8

COPY

Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx

C32

COPY

Malignant neoplasm of larynx

C32.0

COPY

Malignant neoplasm of glottis

C32.1

COPY

Malignant neoplasm of supraglottis

C32.2

COPY

Malignant neoplasm of subglottis

C32.3

COPY

Malignant neoplasm of laryngeal cartilage

C32.8

COPY

Malignant neoplasm of overlapping sites of larynx

C32.9

COPY

Malignant neoplasm of larynx, unspecified

C76

COPY

Malignant neoplasm of other and ill-defined sites

C76.0

COPY

Malignant neoplasm of head, face and neck

Z51.12

COPY

Encounter for antineoplastic immunotherapy

If infusion for antineoplastic immunotherapy is the only reason for the patient encounter, physicians and hospitals may report ICD-10-CM code “Z51.12 Encounter for antineoplastic immunotherapy” as the primary diagnosis.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C65

COPY

Malignant neoplasm of renal pelvis

C65.1

COPY

Malignant neoplasm of the right renal pelvis

C65.2

COPY

Malignant neoplasm of the left renal pelvis

C65.9

COPY

Malignant neoplasm of unspecified renal pelvis

C66

COPY

Malignant neoplasm of ureter

C66.1

COPY

Malignant neoplasm of the right ureter

C66.2

COPY

Malignant neoplasm of the left ureter

C66.9

COPY

Malignant neoplasm of unspecified ureter

C67

COPY

Malignant neoplasm of bladder

C67.0

COPY

Malignant neoplasm of trigone of bladder

C67.1

COPY

Malignant neoplasm of dome of bladder

C67.2

COPY

Malignant neoplasm of lateral wall of bladder

C67.3

COPY

Malignant neoplasm of anterior wall of bladder

C67.4

COPY

Malignant neoplasm of posterior wall of bladder

C67.5

COPY

Malignant neoplasm of bladder neck

C67.6

COPY

Malignant neoplasm of ureteric orifice

C67.8

COPY

Malignant neoplasm of overlapping sites of bladder

C67.9

COPY

Malignant neoplasm of bladder, unspecified

C68

COPY

Malignant neoplasm of other and unspecific urinary organs

C68.0

COPY

Malignant neoplasm of urethra

C68.8

COPY

Malignant neoplasm of overlapping sites of urinary organs

C68.9

COPY

Malignant neoplasm of urinary organ, unspecified

Z51.12

COPY

Encounter for antineoplastic immunotherapy

If infusion for antineoplastic immunotherapy is the only reason for the patient encounter, physicians and hospitals may report ICD-10-CM code “Z51.12 Encounter for antineoplastic immunotherapy” as the primary diagnosis.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C33

COPY

Malignant neoplasm of trachea

C34

COPY

Malignant neoplasm of bronchus and lung

C34.0

COPY

Malignant neoplasm of main bronchus, carina, and hilus of lung

C34.00

COPY

Malignant neoplasm of unspecified main bronchus

C34.01

COPY

Malignant neoplasm of right main bronchus

C34.02

COPY

Malignant neoplasm of left main bronchus

C34.1

COPY

Malignant neoplasm of upper lobe, bronchus or lung

C34.10

COPY

Malignant neoplasm of upper lobe, unspecified bronchus or lung

C34.11

COPY

Malignant neoplasm of upper lobe, right bronchus or lung

C34.12

COPY

Malignant neoplasm of upper lobe, left bronchus or lung

C34.2

COPY

Malignant neoplasm of middle lobe, bronchus or lung

C34.3

COPY

Malignant neoplasm of lower lobe, bronchus or lung

C34.30

COPY

Malignant neoplasm of lower lobe, unspecified bronchus or lung

C34.31

COPY

Malignant neoplasm of lower lobe, right bronchus or lung

C34.32

COPY

Malignant neoplasm of lower lobe, left bronchus or lung

C34.8

COPY

Malignant neoplasm of overlapping sites of bronchus and lung

C34.80

COPY

Malignant neoplasm of overlapping sites of unspecified bronchus and lung

C34.81

COPY

Malignant neoplasm of overlapping sites of right bronchus and lung

C34.82

COPY

Malignant neoplasm of overlapping sites of left bronchus and lung

C34.9

COPY

Malignant neoplasm of unspecified part of bronchus or lung

C34.90

COPY

Malignant neoplasm of unspecified part of bronchus or lung

C34.91

COPY

Malignant neoplasm of unspecified part of right bronchus or lung

C34.92

COPY

Malignant neoplasm of unspecified part of left bronchus or lung

Z51.12

COPY

Encounter for antineoplastic immunotherapy

If infusion for antineoplastic immunotherapy is the only reason for the patient encounter, physicians and hospitals may report ICD-10-CM code “Z51.12 Encounter for antineoplastic immunotherapy” as the primary diagnosis.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C64

COPY

Malignant neoplasm of kidney, except renal pelvis

C64.1

COPY

Malignant neoplasm of right kidney, except renal pelvis

C64.2

COPY

Malignant neoplasm of left kidney, except renal pelvis

C64.9

COPY

Malignant neoplasm of unspecified kidney, except renal pelvis

C65

COPY

Malignant neoplasm of renal pelvis

C65.1

COPY

Malignant neoplasm of right renal pelvis

C65.2

COPY

Malignant neoplasm of left renal pelvis

C65.9

COPY

Malignant neoplasm of unspecified renal pelvis

Z51.12

COPY

Encounter for antineoplastic immunotherapy

If infusion for antineoplastic immunotherapy is the only reason for the patient encounter, physicians and hospitals may report ICD-10-CM code “Z51.12 Encounter for antineoplastic immunotherapy” as the primary diagnosis.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)7

C17

COPY

Malignant neoplasm of small intestine

C17.0

COPY

Malignant neoplasm of duodenum

C17.1

COPY

Malignant neoplasm of jejunum

C17.2

COPY

Malignant neoplasm of ileum

C17.8

COPY

Malignant neoplasm of overlapping sites of small intestine

C17.9

COPY

Malignant neoplasm of small intestine, unspecified

C18

COPY

Malignant neoplasm of colon

C18.0

COPY

Malignant neoplasm of cecum

C18.1

COPY

Malignant neoplasm of appendix

C18.2

COPY

Malignant neoplasm of ascending colon

C18.3

COPY

Malignant neoplasm of hepatic flexure

C18.4

COPY

Malignant neoplasm of transverse colon

C18.5

COPY

Malignant neoplasm of splenic flexure

C18.6

COPY

Malignant neoplasm of descending colon

C18.7

COPY

Malignant neoplasm of sigmoid colon

C18.8

COPY

Malignant neoplasm of overlapping sites of colon

C18.9

COPY

Malignant neoplasm of colon, unspecified

C19

COPY

Malignant neoplasm of rectosigmoid junction

C20

COPY

Malignant neoplasm of rectum

C21

COPY

Malignant neoplasm of anus and anal canal

C21.8

COPY

Malignant neoplasm of overlapping sites of rectum, anus and anal canal

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C22

COPY

Malignant neoplasm of liver and intrahepatic bile ducts

C22.0

COPY

Liver cell carcinoma (hepatocellular carcinoma, hepatoma)

C22.8

COPY

Malignant neoplasm of liver, primary, unspecified as to type

Z51.12

COPY

Encounter for antineoplastic immunotherapy

If infusion for antineoplastic immunotherapy is the only reason for the patient encounter, physicians and hospitals may report ICD-10-CM code “Z51.12 Encounter for antineoplastic immunotherapy” as the primary diagnosis.

OPDIVO and YERVOY may be purchased through the distributors listed below.

Physician offices

Specialty Distributor Phone Orders Website
Cardinal Health Specialty Pharmaceutical Distribution 1-877-453-3972
Monday-Friday,
7 AM-7 PM CT (24-hour emergency on call)
https://specialtyonline.cardinalhealth.com
CuraScript Specialty Distribution 1-866-433-3589
Monday-Friday,
8:30 AM-7 PM ET
https://www.curascriptsd.com
McKesson Specialty Health 1-800-482-6700
Monday-Friday,
7 AM-7 PM CT
https://mscs.mckesson.com
Oncology Supply 1-800-633-7555
Monday-Thursday,
8 AM-7:30 PM CT; Friday, 8 AM-7 PM CT
https://www.oncologysupply.com

Physician offices

Specialty Distributor Phone Orders Website
Cardinal Health Specialty Pharmaceutical Distribution 1-877-453-3972
Monday-Friday,
7 AM-7 PM CT (24-hour emergency on call)
https://specialtyonline.cardinalhealth.com
CuraScript Specialty Distribution 1-866-433-3589
Monday-Friday,
8:30 AM-7 PM ET
https://www.curascriptsd.com
McKesson Specialty Health 1-800-482-6700
Monday-Friday,
7 AM-7 PM CT
https://mscs.mckesson.com
Oncology Supply 1-800-633-7555
Monday-Friday,
8 AM-7 PM CT;
https://www.oncologysupply.com

For offices that prefer to use the services of a specialty pharmacy, specialty pharmacies can obtain OPDIVO and YERVOY from the distributors listed above.

Hospitals and Infusion Centers

Specialty Distributor Phone Orders Fax Orders and Website
ASD Healthcare 1-800-746-6273 Monday-Thursday, 7:30 AM-6:30 PM CT; Friday, 7 AM-6 PM CT (24-hour emergency on call) 1-800-547-9413 https://www.asdhealthcare.com
Cardinal Health Specialty Pharmaceutical Distribution 1-866-677-4844
Monday-Friday,
7 AM-6 PM CT (24-hour emergency on call)
1-888-345-4916 https://orderexpress.cardinalhealth.com
DMS Pharmaceutical Group, Inc. 1-877-788-1100
Monday-Friday,
7:30 AM-6 PM CT
1-847-518-1105
www.dmspharma.com
McKesson Plasma and Biologics 1-877-625-2566
Monday-Friday,
8 AM-6:30 PM CT
1-888-752-7626 https://connect.mckesson.com
Smith Medical Partners 1-800-292-9653
Monday-Thursday,
8 AM-6 PM CT; Friday, 8 AM-4:30 PM CT
1-630-227-9220
www.smpspecialty.com

Hospitals and Infusion Centers

Specialty Distributor Phone Orders Fax Orders and Website
ASD Healthcare 1-800-746-6273 Monday-Thursday, 7:30 AM-6:30 PM CT; Friday, 7 AM-6 PM CT (24-hour emergency on call) 1-800-547-9413 https://www.asdhealthcare.com
Cardinal Health Specialty Pharmaceutical Distribution 1-866-677-4844
Monday-Friday,
7 AM-6 PM CT (24-hour emergency on call)
1-614-553-6301 https://orderexpress.cardinalhealth.com
DMS Pharmaceutical Group, Inc. 1-877-788-1100
Monday-Friday,
7:30 AM-6 PM CT
1-847-518-1105
www.dmspharma.com
McKesson Plasma and Biologics 1-877-625-2566
Monday-Friday,
8 AM-6:30 PM CT
1-888-752-7626 https://connect.mckesson.com
Smith Medical Partners 1-800-292-9653
Monday-Thursday,
8 AM-6 PM CT; Friday, 8 AM-4:30 PM CT
1-630-227-9220
www.smpspecialty.com

Above information is accurate as of 02/18.

Above information is accurate as of 04/17.

Above information is accurate as of 01/17.

Above information is accurate as of 01/18.

Above information is accurate as of 01/18.

Above information is accurate as of 01/18.

Above information is accurate as of 06/18.

Above information is accurate as of 01/18.

Above information is accurate as of 01/18.

Above information is accurate as of 04/18.

Above information is accurate as of 08/17.

The OPDIVO and YERVOY distribution program includes extended payment terms to Bristol-Myers Squibb authorized OPDIVO and YERVOY distributors. Healthcare providers and institutions should contact their OPDIVO and YERVOY distributor to understand specific payment terms that may be available to them from their distributor.

Please see U.S. Full Prescribing Information for OPDIVO.

Please see U.S. Full Prescribing Information for OPDIVO and YERVOY, including Boxed WARNING regarding immune-mediated adverse reactions for YERVOY.

Coding for OPDIVO and YERVOY is dependent on the insurer and the care setting in which the drug will be administered. Oncology practices need to make coding decisions based on the diagnosis and treatment of each patient and the specific insurer requirements.

Please see U.S. Full Prescribing Information for OPDIVO.

Please see U.S. Full Prescribing Information for OPDIVO and YERVOY, including Boxed WARNING regarding immune-mediated adverse reactions for YERVOY.

*Healthcare providers should code healthcare claims based upon the service that is rendered, the patient's medical record, the coding requirements of each health insurer, and best coding practices. Coding information provided under this heading does not provide a guarantee of reimbursement and should be considered together with all applicable coding guidance and standards. All of the coding information presented by this website is applicable to outpatient procedures only.

CPT codes and descriptions only are ©2015201620172016 by American Medical Association (AMA). All rights reserved. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association.

References:

  1. American Medical Association. 2017 HCPCS Level II. 2018 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2017.
  2. Centers for Medicare & Medicaid Services. MLN Matters, Number MM9603 Revised. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf. Revised June 10, 2016. Accessed January 12, 2017.January 11, 2018.
  3. Palmetto GBA. Medicare Part A Billing Guide. October 2016May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pf/$File/Part_A_Billing_Guide.pdf. Accessed January 12, 2017January 11, 2018.
  4. American Medical Association. Current Procedural Terminology 20172018. Professional ed. Chicago, IL: American Medical Association; 20162017.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. American Medical Association. 20172018 ICD-10-CM: The Complete Official Codebook. Chicago, IL: American Medical Association; 20162017.

*Healthcare providers should code healthcare claims based upon the service that is rendered, the patient's medical record, the coding requirements of each health insurer, and best coding practices. Coding information provided under this heading does not provide a guarantee of reimbursement and should be considered together with all applicable coding guidance and standards. All of the coding information presented by this website is applicable to outpatient procedures only.

CPT codes and descriptions only are ©201720162016 by American Medical Association (AMA). All rights reserved. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association.

References:

  1. American Medical Association. 2018 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2017.
  2. Centers for Medicare & Medicaid Services. MLN Matters, Number MM9603 Revised. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf. Revised June 10, 2016. Accessed May 5, 2017.
  3. Palmetto GBA. Medicare Part A Billing Guide. March 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pf/$File/Part_A_Billing_Guide.pdf. Accessed May 5, 2017.
  4. American Medical Association. Current Procedural Terminology 2018. Professional ed. Chicago, IL: American Medical Association; 2017.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. YERVOY [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  7. American Medical Association. 2018 ICD-10-CM: The Complete Official Codebook. Chicago, IL: American Medical Association; 2017.

The accurate completion of reimbursement- or coverage-related documentation is the responsibility of the healthcare provider and patient. Bristol-Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.

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