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.
*Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving OPDIVO.
OPDIVO in combination with YERVOY® (ipilimumab) for the first-line treatment of patients with intermediate or poor risk, previously untreated advanced RCC
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.
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.
Healthcare Common Procedure Coding System (HCPCS) Codes1Issued 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
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
J9299
COPY
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
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
COPY
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
COPY
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
COPY
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
COPY
Drugs requiring detailed coding
0335
COPY
Chemotherapy administration, IV
0260
COPY
IV solutions
MSI/MMR CPT Testing Codes4
88342
COPY
Immunohisto chemistry or immunocyto chemistry, per specimen; initial single antibody stain procedure
+88341
COPY
Each additional single antibody stain procedure
81301
COPY
Microsatellite instability analysis
96413
COPY
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)
Current Procedural Terminology (CPT)4,†
OPDIVO
96413
COPY
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96413
COPY
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
COPY
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
COPY
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
COPY
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
COPY
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
COPY
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
COPY
Immunohisto chemistry or immunocyto chemistry, per specimen; initial single antibody stain procedure
+88341
COPY
Each additional single antibody stain procedure
81301
COPY
Microsatellite instability analysis
National Drug Codes (NDC)5Issued 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
COPY
40 mg/4 mL (10 mg/mL) single-dose vial
00003-3774-12
COPY
100 mg/10 mL (10 mg/mL) single-dose vial
00003-3734-13
COPY
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
COPY
One 50-mg vial (5 mg/mL), single-use vial
00003-2328-22
COPY
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
COPY
One 50-mg vial (5 mg/mL), single-use vial
00003-2328-22
COPY
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
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
C43.111
COPY
Malignant melanoma of right upper eyelid, including canthus
C43.112
COPY
Malignant melanoma of right lower eyelid, including canthus
C43.12
COPY
Malignant melanoma of left eyelid, including canthus
C43.121
COPY
Malignant melanoma of left upper eyelid, including canthus
C43.122
COPY
Malignant melanoma of left lower 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)7
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)6
C81
COPY
Hodgkin lymphoma
C81.1
COPY
Nodular sclerosis Hodgkin lymphoma
C81.10
COPY
Nodular sclerosis Hodgkin lymphoma, unspecified site
C81.11
COPY
Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck
Lymphocyte-rich Hodgkin lymphoma, lymph nodes of multiple sites
C81.49
COPY
Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites
C81.7
COPY
Other Hodgkin lymphoma
C81.70
COPY
Other Hodgkin lymphoma, unspecified site
C81.71
COPY
Other Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.72
COPY
Other Hodgkin lymphoma, intrathoracic lymph nodes
C81.73
COPY
Other Hodgkin lymphoma, intra-abdominal lymph nodes
C81.74
COPY
Other Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.75
COPY
Other Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.76
COPY
Other Hodgkin lymphoma, intrapelvic lymph nodes
C81.77
COPY
Other Hodgkin lymphoma, spleen
C81.78
COPY
Other Hodgkin lymphoma, lymph nodes of multiple sites
C81.79
COPY
Other Hodgkin lymphoma, extranodal and solid organ sites
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.
Z94.84
COPY
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
COPY
Malignant neoplasm of lip
C00.0
COPY
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
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
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)
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
Physician offices
Specialty Distributor
Phone Orders
Website
Cardinal Health Specialty Pharmaceutical Distribution
1-877-453-3972 Monday-Friday, 7 AM-6 PM CT(24-hour emergency on call)
https://specialtyonline.cardinalhealth.com
CuraScript Specialty Distribution
1-866-433-3589 Monday-Friday, 8 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.
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 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 and YERVOY, including Boxed WARNING regarding immune-mediated adverse reactions for YERVOY.
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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