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Formulary
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 in adults
- Codes*
- Distribution
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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
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Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
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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
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.
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One 50-mg vial (5 mg/mL), single-use vial
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One 200-mg vial (5 mg/mL), single-use vial
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 |
https://specialtyonline.cardinalhealth.com |
| CuraScript Specialty Distribution | 1-866-433-3589 |
http://www.curascriptsd.com |
| McKesson Specialty Health | 1-800-482-6700 |
https://mscs.mckesson.com |
| Oncology Supply | 1-800-633-7555 |
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 |
1-800-547-9413 https://www.asdhealthcare.com |
| Cardinal Health Specialty Pharmaceutical Distribution | 1-866-677-4844 |
1-888-345-4916 https://specialtyonline.cardinalhealth.com |
| DMS Pharmaceutical Group, Inc. | 1-877-788-1100 |
1-847-518-1105 www.dmspharma.com |
| McKesson Plasma and Biologics | 1-877-625-2566 |
1-888-752-7626 https://connect.mckesson.com |
| Smith Medical Partners | 1-800-292-9653 |
1-630-227-9220www.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.
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.