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
Diagnosis Codes

Locally Advanced or Metastatic Urothelial Carcinoma (UC)

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 Therapy-General

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
C65

Malignant neoplasm of renal pelvis

C65.1

Malignant neoplasm of the right renal pelvis

C65.2

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Malignant neoplasm of the left renal pelvis

C65.9

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Malignant neoplasm of unspecified renal pelvis

C66

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Malignant neoplasm of ureter

C66.1

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Malignant neoplasm of the right ureter

C66.2

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Malignant neoplasm of the left ureter

C66.9

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Malignant neoplasm of unspecified ureter

C67

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Malignant neoplasm of bladder

C67.0

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Malignant neoplasm of trigone of bladder

C67.1

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Malignant neoplasm of dome of bladder

C67.2

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Malignant neoplasm of lateral wall of bladder

C67.3

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Malignant neoplasm of anterior wall of bladder

C67.4

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Malignant neoplasm of posterior wall of bladder

C67.5

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Malignant neoplasm of bladder neck

C67.6

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Malignant neoplasm of ureteric orifice

C67.8

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Malignant neoplasm of overlapping sites of bladder

C67.9

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Malignant neoplasm of bladder, unspecified

C68

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Malignant neoplasm of other and unspecified urinary organs

C68.0

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Malignant neoplasm of urethra

C68.8

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Malignant neoplasm of overlapping sites of urinary organs

C68.9

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Malignant neoplasm of urinary organ, unspecified

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.

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://specialty
online.cardinal
health.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://order
express.cardinal
health.com
DMS Pharmaceutical Group, Inc. 1-877-788-1100
Monday-Friday,
8:30 AM-5 PM CT
1-847-518-1105
www.dms
pharma.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.smp
specialty.com

Above information is accurate as of 07/20.

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.

FDA Approval Letters as Posted by the FDA:

OPDIVO for the treatment of patients with locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or have disease progression within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy – Approved on 02/02/2017

View Letter

Flat Dosing for OPDIVO (480 mg every 4 weeks) - Approved on 03/05/2018

View Letter

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

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 ©2019 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. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  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 November 15, 2019.
  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 October 10, 2019.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. American Medical Association. 2020 ICD-10-CM: The Complete Official Codebook. Chicago, IL: American Medical Association; 2019.

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 07/20.

1506US2001674-01-01 07/20