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.

Billing and Diagnostic Codes icon

Billing and
Diagnosis Codes

Small Cell Lung Cancer (SCLC)

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 OPDIVO

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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
J9299

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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

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

National Drug Codes (NDC)5 Issued 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.

00003-3772-11

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40 mg/4 mL (10 mg/mL) single-dose vial

00003-3774-12

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100 mg/10 mL (10 mg/mL) single-dose vial

00003-3734-13

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240 mg/24 mL (10 mg/mL) single-dose vial

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6
C33

Malignant neoplasm of trachea

C34

Malignant neoplasm of bronchus and lung

C34.0

Malignant neoplasm of main bronchus, carina, and hilus of lung

C34.00

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Malignant neoplasm of unspecified main bronchus

C34.01

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Malignant neoplasm of right main bronchus

C34.02

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Malignant neoplasm of left main bronchus

C34.1

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Malignant neoplasm of upper lobe, bronchus or lung

C34.10

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Malignant neoplasm of upper lobe, unspecified bronchus or lung

C34.11

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Malignant neoplasm of upper lobe, right bronchus or lung

C34.12

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Malignant neoplasm of upper lobe, left bronchus or lung

C34.2

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Malignant neoplasm of middle lobe, bronchus or lung

C34.3

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Malignant neoplasm of lower lobe, bronchus or lung

C34.30

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Malignant neoplasm of lower lobe, unspecified bronchus or lung

C34.31

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Malignant neoplasm of lower lobe, right bronchus or lung

C34.32

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Malignant neoplasm of lower lobe, left bronchus or lung

C34.8

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Malignant neoplasm of overlapping sites of bronchus and lung

C34.80

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Malignant neoplasm of overlapping sites of unspecified bronchus and lung

C34.81

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Malignant neoplasm of overlapping sites of right bronchus and lung

C34.82

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Malignant neoplasm of overlapping sites of left bronchus and lung

C34.9

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Malignant neoplasm of unspecified part of bronchus or lung

C34.90

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Malignant neoplasm of unspecified part of bronchus or lung

C34.91

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Malignant neoplasm of unspecified part of right bronchus or lung

C34.92

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Malignant neoplasm of unspecified part of left bronchus or lung

Z51.12   

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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.

Coding for OPDIVO 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.

*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 information 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 ©2018 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. 2019 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2019.
  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 11, 2018.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed January 11, 2018.
  4. American Medical Association. Current Procedural Terminology 2019. Professional ed. Chicago, IL: American Medical Association; 2018.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. American Medical Association. 2019 ICD-10-CM: The Complete Official Codebook. Chicago, IL: American Medical Association; 2018.

OPDIVO 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 OPDIVO 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 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 01/19.

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

Please see U.S. Full Prescribing Information for OPDIVO.

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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1506US1804546-01-01 01/19