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Billing and
Diagnosis Codes

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.

Reimbursement and Coding Guide for ORENCIA


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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
J0129

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Injection, abatacept, 10 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

Current Procedural Terminology (CPT)3,†
Intravenous Use Only
96413

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

96365

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Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour

Subcutaneous Injection Only
96372

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Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

National Drug Codes (NDC)4 Issued by the FDA

Note:Payers require the submission of the 10-digit NDC on healthcare claim forms. Please use the 10-digit codes shown here.

Intravenous Use Only

For Adults with Rheumatoid Arthritis (RA) and for Juvenile Idiopathic Arthritis (JIA) Ages 6-17

0003-2187-10

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250 mg in a 15-mL single-use vial

Subcutaneous Injection Only for Adults with RA
0003-2188-11

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Pack of 4 single-dose syringes with a passive needle safety guard (125 mg/1 mL pre-filled syringe)

0003-2188-51

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Pack of 4 single-dose autoinjectors (125 mg/1 mL)

Subcutaneous Injection Only for Moderate to Severe JIA Ages 2-17
0003-2814-11

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Pack of 4 syringes with a passive needle safety guard (50 mg/0.4 mL pre-filled syringe)

0003-2818-11

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Pack of 4 syringes with a passive needle safety guard (87.5 mg/0.7 mL pre-filled syringe)

0003-2188-11

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Pack of 4 syringes with a passive needle safety guard (125 mg/1 mL pre-filled syringe)

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)5

Adult Rheumatoid Arthritis
M05.7

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Rheumatoid arthritis with rheumatoid factor without organ or systems involvement

M05.70

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Rheumatoid arthritis with rheumatoid factor of unspecified site without organ or systems involvement

M05.71

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Rheumatoid arthritis with rheumatoid factor of shoulder without organ or systems involvement

M05.711

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Rheumatoid arthritis with rheumatoid factor of right shoulder without organ or systems involvement

M05.712

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Rheumatoid arthritis with rheumatoid factor of left shoulder without organ or systems involvement

M05.719

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Rheumatoid arthritis with rheumatoid factor of unspecified shoulder without organ or systems involvement

M05.72

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Rheumatoid arthritis with rheumatoid factor of elbow without organ or systems involvement

M05.721

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Rheumatoid arthritis with rheumatoid factor of right elbow without organ or systems involvement

M05.722

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Rheumatoid arthritis with rheumatoid factor of left elbow without organ or systems involvement

M05.729

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Rheumatoid arthritis with rheumatoid factor of unspecified elbow without organ or systems involvement

M05.73

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Rheumatoid arthritis with rheumatoid factor of wrist without organ or systems involvement

M05.731

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Rheumatoid arthritis with rheumatoid factor of right wrist without organ or systems involvement

M05.732

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Rheumatoid arthritis with rheumatoid factor of left wrist without organ or systems involvement

M05.739

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Rheumatoid arthritis with rheumatoid factor of unspecified wrist without organ or systems involvement

M05.74

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Rheumatoid arthritis with rheumatoid factor of hand without organ or systems involvement

M05.741

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Rheumatoid arthritis with rheumatoid factor of right hand without organ or systems involvement

M05.742

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Rheumatoid arthritis with rheumatoid factor of left hand without organ or systems involvement

M05.749

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Rheumatoid arthritis with rheumatoid factor of unspecified hand without organ or systems involvement

M05.75

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Rheumatoid arthritis with rheumatoid factor of hip without organ or systems involvement

M05.751

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Rheumatoid arthritis with rheumatoid factor of right hip without organ or systems involvement

M05.752

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Rheumatoid arthritis with rheumatoid factor of left hip without organ or systems involvement

M05.759

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Rheumatoid arthritis with rheumatoid factor of unspecified hip without organ or systems involvement

M05.76

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Rheumatoid arthritis with rheumatoid factor of knee without organ or systems involvement

M05.761

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Rheumatoid arthritis with rheumatoid factor of right knee without organ or systems involvement

M05.762

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Rheumatoid arthritis with rheumatoid factor of left knee without organ or systems involvement

M05.769

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Rheumatoid arthritis with rheumatoid factor of unspecified knee without organ or systems involvement

M05.77

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Rheumatoid arthritis with rheumatoid factor of ankle and foot without organ or systems involvement

M05.771

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Rheumatoid arthritis with rheumatoid factor of right ankle and foot without organ or systems involvement

M05.772

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Rheumatoid arthritis with rheumatoid factor of left ankle and foot without organ or systems involvement

M05.779

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Rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot without organ or systems involvement

M05.79

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Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement

M05.8

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Other rheumatoid arthritis with rheumatoid factor

M05.80

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Other rheumatoid arthritis with rheumatoid factor of unspecified site

M05.81

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Other rheumatoid arthritis with rheumatoid factor of shoulder

M05.811

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Other rheumatoid arthritis with rheumatoid factor of right shoulder

M05.812

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Other rheumatoid arthritis with rheumatoid factor of left shoulder

M05.819

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Other rheumatoid arthritis with rheumatoid factor of unspecified shoulder

M05.82

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Other rheumatoid arthritis with rheumatoid factor of elbow

M05.821

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Other rheumatoid arthritis with rheumatoid factor of right elbow

M05.822

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Other rheumatoid arthritis with rheumatoid factor of left elbow

M05.829

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Other rheumatoid arthritis with rheumatoid factor of unspecified elbow

M05.83

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Other rheumatoid arthritis with rheumatoid factor of wrist

M05.831

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Other rheumatoid arthritis with rheumatoid factor of right wrist

M05.832

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Other rheumatoid arthritis with rheumatoid factor of left wrist

M05.839

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Other rheumatoid arthritis with rheumatoid factor of unspecified wrist

M05.84

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Other rheumatoid arthritis with rheumatoid factor of hand

M05.841

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Other rheumatoid arthritis with rheumatoid factor of right hand

M05.842

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Other rheumatoid arthritis with rheumatoid factor of left hand

M05.849

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Other rheumatoid arthritis with rheumatoid factor of unspecified hand

M05.85

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Other rheumatoid arthritis with rheumatoid factor of hip

M05.851

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Other rheumatoid arthritis with rheumatoid factor of right hip

M05.852

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Other rheumatoid arthritis with rheumatoid factor of left hip

M05.859

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Other rheumatoid arthritis with rheumatoid factor of unspecified hip

M05.86

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Other rheumatoid arthritis with rheumatoid factor of knee

M05.861

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Other rheumatoid arthritis with rheumatoid factor of right knee

M05.862

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Other rheumatoid arthritis with rheumatoid factor of left knee

M05.869

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Other rheumatoid arthritis with rheumatoid factor of unspecified knee

M05.87

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Other rheumatoid arthritis with rheumatoid factor of ankle and foot

M05.871

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Other rheumatoid arthritis with rheumatoid factor of right ankle and foot

M05.872

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Other rheumatoid arthritis with rheumatoid factor of left ankle and foot

M05.879

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Other rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot

M05.89

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Other rheumatoid arthritis with rheumatoid factor of multiple sites

M05.9

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Rheumatoid arthritis with rheumatoid factor, unspecified

M06.0

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Rheumatoid arthritis without rheumatoid factor

M06.00

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Rheumatoid arthritis without rheumatoid factor, unspecified site

M06.01

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Rheumatoid arthritis without rheumatoid factor, shoulder

M06.011

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Rheumatoid arthritis without rheumatoid factor, right shoulder

M06.012

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Rheumatoid arthritis without rheumatoid factor, left shoulder

M06.019

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Rheumatoid arthritis without rheumatoid factor, unspecified shoulder

M06.02

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Rheumatoid arthritis without rheumatoid factor, elbow

M06.021

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Rheumatoid arthritis without rheumatoid factor, right elbow

M06.022

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Rheumatoid arthritis without rheumatoid factor, left elbow

M06.029

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Rheumatoid arthritis without rheumatoid factor, unspecified elbow

M06.03

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Rheumatoid arthritis without rheumatoid factor, wrist

M06.031

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Rheumatoid arthritis without rheumatoid factor, right wrist

M06.032

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Rheumatoid arthritis without rheumatoid factor, left wrist

M06.039

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Rheumatoid arthritis without rheumatoid factor, unspecified wrist

M06.04

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Rheumatoid arthritis without rheumatoid factor, hand

M06.041

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Rheumatoid arthritis without rheumatoid factor, right hand

M06.042

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Rheumatoid arthritis without rheumatoid factor, left hand

M06.049

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Rheumatoid arthritis without rheumatoid factor, unspecified hand

M06.05

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Rheumatoid arthritis without rheumatoid factor, hip

M06.051

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Rheumatoid arthritis without rheumatoid factor, right hip

M06.052

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Rheumatoid arthritis without rheumatoid factor, left hip

M06.059

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Rheumatoid arthritis without rheumatoid factor, unspecified hip

M06.06

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Rheumatoid arthritis without rheumatoid factor, knee

M06.061

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Rheumatoid arthritis without rheumatoid factor, right knee

M06.062

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Rheumatoid arthritis without rheumatoid factor, left knee

M06.069

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Rheumatoid arthritis without rheumatoid factor, unspecified knee

M06.07

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Rheumatoid arthritis without rheumatoid factor, ankle and foot

M06.071

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Rheumatoid arthritis without rheumatoid factor, right ankle and foot

M06.072

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Rheumatoid arthritis without rheumatoid factor, left ankle and foot

M06.079

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Rheumatoid arthritis without rheumatoid factor, unspecified ankle and foot

M06.08

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Rheumatoid arthritis without rheumatoid factor, vertebrae

M06.09

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Rheumatoid arthritis without rheumatoid factor, multiple sites

Juvenile Idiopathic Arthritis For patients with moderate to severe juvenile idiopathic arthritis (JIA), ORENCIA may be administered as an intravenous infusion (6 years of age and older) or a subcutaneous injection (2 years of age and older). Intravenous dosing has not been studied in patients younger than 6 years of age. The safety and efficacy of ORENCIA ClickJect autoinjector for subcutaneous injection has not been studied in patients under 18 years of age.
M08.0

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Unspecified juvenile rheumatoid arthritis

M08.00

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Unspecified juvenile rheumatoid arthritis of unspecified site

M08.01

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Unspecified juvenile rheumatoid arthritis, shoulder

M08.011

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Unspecified juvenile rheumatoid arthritis, right shoulder

M08.012

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Unspecified juvenile rheumatoid arthritis, left shoulder

M08.019

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Unspecified juvenile rheumatoid arthritis, unspecified shoulder

M08.02

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Unspecified juvenile rheumatoid arthritis, elbow

M08.021

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Unspecified juvenile rheumatoid arthritis, right elbow

M08.022

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Unspecified juvenile rheumatoid arthritis, left elbow

M08.029

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Unspecified juvenile rheumatoid arthritis, unspecified elbow

M08.03

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Unspecified juvenile rheumatoid arthritis, wrist

M08.031

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Unspecified juvenile rheumatoid arthritis, right wrist

M08.032

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Unspecified juvenile rheumatoid arthritis, left wrist

M08.039

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Unspecified juvenile rheumatoid arthritis, unspecified wrist

M08.04

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Unspecified juvenile rheumatoid arthritis, hand

M08.041

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Unspecified juvenile rheumatoid arthritis, right hand

M08.042

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Unspecified juvenile rheumatoid arthritis, left hand

M08.049

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Unspecified juvenile rheumatoid arthritis, unspecified hand

M08.05

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Unspecified juvenile rheumatoid arthritis, hip

M08.051

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Unspecified juvenile rheumatoid arthritis, right hip

M08.052

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Unspecified juvenile rheumatoid arthritis, left hip

M08.059

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Unspecified juvenile rheumatoid arthritis, unspecified hip

M08.06

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Unspecified juvenile rheumatoid arthritis, knee

M08.061

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Unspecified juvenile rheumatoid arthritis, right knee

M08.062

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Unspecified juvenile rheumatoid arthritis, left knee

M08.069

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Unspecified juvenile rheumatoid arthritis, unspecified knee

M08.07

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Unspecified juvenile rheumatoid arthritis, ankle and foot

M08.071

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Unspecified juvenile rheumatoid arthritis, right ankle and foot

M08.072

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Unspecified juvenile rheumatoid arthritis, left ankle and foot

M08.079

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Unspecified juvenile rheumatoid arthritis, unspecified ankle and foot

M08.08

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Unspecified juvenile rheumatoid arthritis, vertebrae

M08.09

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Unspecified juvenile rheumatoid arthritis, multiple sites

M08.2

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Juvenile rheumatoid arthritis with systemic onset

M08.20

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Juvenile rheumatoid arthritis with systemic onset, unspecified site

M08.21

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Juvenile rheumatoid arthritis with systemic onset, shoulder

M08.211

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Juvenile rheumatoid arthritis with systemic onset, right shoulder

M08.212

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Juvenile rheumatoid arthritis with systemic onset, left shoulder

M08.219

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Juvenile rheumatoid arthritis with systemic onset, unspecified shoulder

M08.22

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Juvenile rheumatoid arthritis with systemic onset, elbow

M08.221

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Juvenile rheumatoid arthritis with systemic onset, right elbow

M08.222

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Juvenile rheumatoid arthritis with systemic onset, left elbow

M08.229

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Juvenile rheumatoid arthritis with systemic onset, unspecified elbow

M08.23

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Juvenile rheumatoid arthritis with systemic onset, wrist

M08.231

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Juvenile rheumatoid arthritis with systemic onset, right wrist

M08.232

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Juvenile rheumatoid arthritis with systemic onset, left wrist

M08.239

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Juvenile rheumatoid arthritis with systemic onset, unspecified wrist

M08.24

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Juvenile rheumatoid arthritis with systemic onset, hand

M08.241

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Juvenile rheumatoid arthritis with systemic onset, right hand

M08.242

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Juvenile rheumatoid arthritis with systemic onset, left hand

M08.249

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Juvenile rheumatoid arthritis with systemic onset, unspecified hand

M08.25

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Juvenile rheumatoid arthritis with systemic onset, hip

M08.251

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Juvenile rheumatoid arthritis with systemic onset, right hip

M08.252

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Juvenile rheumatoid arthritis with systemic onset, left hip

M08.259

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Juvenile rheumatoid arthritis with systemic onset, unspecified hip

M08.26

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Juvenile rheumatoid arthritis with systemic onset, knee

M08.261

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Juvenile rheumatoid arthritis with systemic onset, right knee

M08.262

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Juvenile rheumatoid arthritis with systemic onset, left knee

M08.269

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Juvenile rheumatoid arthritis with systemic onset, unspecified knee

M08.27

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Juvenile rheumatoid arthritis with systemic onset, ankle and foot

M08.271

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Juvenile rheumatoid arthritis with systemic onset, right ankle and foot

M08.272

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Juvenile rheumatoid arthritis with systemic onset, left ankle and foot

M08.279

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Juvenile rheumatoid arthritis with systemic onset, unspecified ankle and foot

M08.28

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Juvenile rheumatoid arthritis with systemic onset, vertebrae

M08.29

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Juvenile rheumatoid arthritis with systemic onset, multiple sites

M08.3

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Juvenile rheumatoid polyarthritis (seronegative)

M08.4

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Pauciarticular juvenile rheumatoid arthritis

M08.40

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Pauciarticular juvenile rheumatoid arthritis, unspecified site

M08.41

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Pauciarticular juvenile rheumatoid arthritis, shoulder

M08.411

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Pauciarticular juvenile rheumatoid arthritis, right shoulder

M08.412

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Pauciarticular juvenile rheumatoid arthritis, left shoulder

M08.419

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Pauciarticular juvenile rheumatoid arthritis, unspecified shoulder

M08.42

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Pauciarticular juvenile rheumatoid arthritis, elbow

M08.421

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Pauciarticular juvenile rheumatoid arthritis, right elbow

M08.422

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Pauciarticular juvenile rheumatoid arthritis, left elbow

M08.429

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Pauciarticular juvenile rheumatoid arthritis, unspecified elbow

M08.43

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Pauciarticular juvenile rheumatoid arthritis, wrist

M08.431

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Pauciarticular juvenile rheumatoid arthritis, right wrist

M08.432

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Pauciarticular juvenile rheumatoid arthritis, left wrist

M08.439

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Pauciarticular juvenile rheumatoid arthritis, unspecified wrist

M08.44

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Pauciarticular juvenile rheumatoid arthritis, hand

M08.441

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Pauciarticular juvenile rheumatoid arthritis, right hand

M08.442

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Pauciarticular juvenile rheumatoid arthritis, left hand

M08.449

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Pauciarticular juvenile rheumatoid arthritis, unspecified hand

M08.45

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Pauciarticular juvenile rheumatoid arthritis, hip

M08.451

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Pauciarticular juvenile rheumatoid arthritis, right hip

M08.452

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Pauciarticular juvenile rheumatoid arthritis, left hip

M08.459

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Pauciarticular juvenile rheumatoid arthritis, unspecified hip

M08.46

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Pauciarticular juvenile rheumatoid arthritis, knee

M08.461

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Pauciarticular juvenile rheumatoid arthritis, right knee

M08.462

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Pauciarticular juvenile rheumatoid arthritis, left knee

M08.469

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Pauciarticular juvenile rheumatoid arthritis, unspecified knee

M08.47

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Pauciarticular juvenile rheumatoid arthritis, ankle and foot

M08.471

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Pauciarticular juvenile rheumatoid arthritis, right ankle and foot

M08.472

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Pauciarticular juvenile rheumatoid arthritis, left ankle and foot

M08.479

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Pauciarticular juvenile rheumatoid arthritis, unspecified ankle and foot

M08.48

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Pauciarticular juvenile rheumatoid arthritis, vertebrae

EMPLICITI may be purchased through the distributors listed below.

Physician offices

Specialty Distributor Phone Orders Website
Cardinal Health Specialty Pharmaceutical Distribution 1-866-677-4844 Monday-Friday, 7 AM-7 PM CT (24-hour emergency on call) https://specialtyonline.cardinalhealth.com
CuraScript Specialty Distribution 1-877-599-7748 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

For offices that prefer to use the services of a specialty pharmacy, specialty pharmacies can obtain EMPLICITI 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, 8 AM-6 PM CT 1-847-518-1105 www.dmspharma.com
McKesson Plasma and Biologics 1-877-625-2566 Monday-Friday, 8 AM-6 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 04/16.

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

 
 

*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 guidance 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 ©2015 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. 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.
  3. American Medical Association. Current Procedural Terminology 2017. Professional ed. Chicago, IL: American Medical Association; 2016.
  4. ORENCIA (abatacept) [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  5. American Medical Association. 2017 ICD-10-CM: The Complete Official Codebook. Chicago, IL: American Medical Association; 2016.

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.

427US1605615-02-01 05/17

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Use of the information on this site is subject to the terms of our Legal Notice and Privacy Statement. The coding, coverage, and payment information contained within this website is current as of 03/17.

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