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YERVOY® (ipilimumab)

Billing and Diagnostic Codes icon

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 YERVOY

FDA Approval Letters as Posted by the FDA:

For the adjuvant treatment of fully resected stage III melanoma (lymph node >1 mm)

For the treatment of unresectable or metastatic melanoma to include pediatric patients (12 years and older)

For the treatment of unresectable or metastatic melanoma in adults

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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
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

Current Procedural Terminology (CPT)3,†
96413

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


96415

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Chemotherapy administration, IV infusion; each additional hour
- List separately in addition to code for primary procedures
- Use 96415 in conjunction with 96413
- Report 96415 for infusion intervals of greater than 30 minutes beyond 1-hour increments

National Drug Codes (NDC)4 Issued by the FDA

Note:The NDCs for YERVOY, shown here, are often necessary in addition to the appropriate J- or C-code when filing a claim for reimbursement.

0003-2327-11

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

0003-2328-22

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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)5

C43

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Malignant melanoma of skin

C43.0

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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

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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

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Malignant melanoma of scalp and neck

C43.5

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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

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Malignant melanoma of other part of trunk

C43.6

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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

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Malignant melanoma of left upper limb, including shoulder

C43.7

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Malignant melanoma of lower limb, including hip

C43.70

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Malignant melanoma of unspecified lower limb, including hip

C43.71

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Malignant melanoma of right lower limb, including hip

C43.72

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Malignant melanoma of left lower limb, including hip

C43.8

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Malignant melanoma of overlapping sites of skin

C43.9

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Malignant melanoma of skin, unspecified

C21

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Malignant neoplasm of anus and anal canal

C21.0

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Malignant neoplasm of anus, unspecified

C21.1

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Malignant neoplasm of anal canal

C51

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Malignant neoplasm of vulva

C51.0

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Malignant neoplasm of labium majus

C51.1

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Malignant neoplasm of labium minus

C51.2

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Malignant neoplasm of clitoris

C51.9

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Malignant neoplasm of vulva, unspecified

C52

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Malignant neoplasm of vagina

C57

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Malignant neoplasm of other and unspecified female genital organs

C57.7

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Malignant neoplasm of other specified female genital organs

C57.8

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Malignant neoplasm of overlapping sites of female genital organs

C57.9

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Malignant neoplasm of female genital organ, unspecified

C60

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Malignant neoplasm of penis

C60.0

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Malignant neoplasm of prepuce

C60.1

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Malignant neoplasm of glans penis

C60.8

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Malignant neoplasm of overlapping sites of penis

C60.9

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Malignant neoplasm of penis, unspecified

C63

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Malignant neoplasm of other and unspecified male genital organs

C63.0

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Malignant neoplasm of epididymis

C63.00

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Malignant neoplasm of unspecified epididymis

C63.01

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Malignant neoplasm of right epididymis

C63.02

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Malignant neoplasm of left epididymis

C63.1

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Malignant neoplasm of spermatic cord

C63.10

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Malignant neoplasm of unspecified spermatic cord

C63.11

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Malignant neoplasm of right spermatic cord

C63.12

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Malignant neoplasm of left spermatic cord

C63.2

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Malignant neoplasm of scrotum

C63.7

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Malignant neoplasm of other specified male genital organs

C63.8

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Malignant neoplasm of overlapping sites of male genital organs

C63.9

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Malignant neoplasm of male genital organ, unspecified

Z51.12

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Encounter for antineoplastic immunotherapy (only)

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.

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-6 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 http://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 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://specialtyonline.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 01/18.

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


Coding for 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.

*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 ©2017 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 January 12, 2017.
  3. American Medical Association. Current Procedural Terminology 2018. Professional ed. Chicago, IL: American Medical Association; 2017.
  4. YERVOY (ipilimumab) [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  5. 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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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 01/18.

731US1800118-01-01 01/18