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 EMPLICITI

FDA Approval Letters as Posted by the FDA:

FDA Letter — in combination with pomalidomide and dexamethasone for the treatment of adult patients with multiple myeloma after at least two prior therapies including lenalidomide and a proteasome inhibitor

FDA Letter — in combination with lenalidomide and dexamethasone for the treatment of adult patients with multiple myeloma after one to three prior therapies

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

J9176

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Injection, elotuzumab, 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 records²

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

Current Procedural Terminology (CPT)^4,†

96413

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

Ambulatory Payment Classification (APC)⁵: 5695, Level V Drug Administration

96415

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Each additional hour
• List separately in addition to code for primary procedure
• Use 96415 in conjunction with 96413
• Report 96415 for infusion intervals of greater than 30 minutes
beyond 1-hour increments

Ambulatory Payment Classification (APC)⁵: 5692, Level II Drug Administration

National Drug Codes (NDC)⁶Issued 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.

00003-2291-11

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300-mg single-dose vial

00003-4522-11

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400-mg single-dose vial

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

C90

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Multiple myeloma and malignant plasma cell neoplasms

C90.0

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Multiple myeloma

C90.00

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Multiple myeloma not having achieved remission

C90.02

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Multiple myeloma in relapse

EMPLICITI 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 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 EMPLICITI from the below-listed distributors.

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, 8:30 AM-5 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 10/2018.

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.

Coding for EMPLICITI 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:

American Medical Association. 2018 HCPCS Level II, Professional Edition. Chicago, IL: American Medical Association; 2017.
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 June 14, 2017.
Palmetto GBA. Medicare Part A Billing Guide. March 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files
/Part_A_Billing_ Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed March 19, 2018.
American Medical Association. Current Procedural Terminology 2018. Professional ed. Chicago, IL: American Medical Association; 2017.
Centers for Medicare & Medicaid Services. January 2016 Integrated OCE Summary. https://www.cms.gov/Medicare
/Coding/OutpatientCodeEdit/Downloads/2016-Jan-IOCESummary.pdf. Accessed January 12, 2018.
EMPLICITI (elotuzumab) [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
American Medical Association. 2019 ICD-10-CM: The Complete Official Codebook. Chicago, IL: American Medical Association; 2018.

Billing and Diagnosis Codes

Physician Offices

Hospitals and Infusion Centers

Billing and
Diagnosis Codes