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

Adjuvant Treatment of Resected Esophageal or Gastroesophageal Junction Cancer

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

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

Drugs requiring detailed coding

0335

Chemotherapy administration, IV

0260

IV Therapy-General

Current Procedural Terminology (CPT)4,†
96413

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

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

00003-3774-12

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

00003-3756-14

COPY

120 mg/12 mL (10 mg/mL) single-dose vial

00003-3734-13

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

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6
C15

Malignant neoplasm of esophagus

C15.3

Malignant neoplasm of upper third of esophagus

C15.4

Malignant neoplasm of middle third of esophagus

C15.5

Malignant neoplasm of lower third of esophagus

C15.8

Malignant neoplasm of overlapping sites of esophagus

C15.9

Malignant neoplasm of esophagus, unspecified

C16

Malignant neoplasm of stomach

C16.0

Malignant neoplasm of cardia

Z51.12

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 Fax Orders and Website
Besse Medical 1-888-711-5469
Monday-Friday,
7 AM-11 PM ET
https://www.besse
.com
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 1-877-599-7748
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
Morris & Dickson Specialty 1-800-710-6100
Monday-Friday,
8 AM-6 PM CT
Fax: 1-318-524-3096
https://www.
mdspecialtydist.
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
Fax: 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)
Fax: 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
Fax: 1-847-518-1105
www.dms
pharma.com
McKesson Plasma and Biologics 1-877-625-2566
Monday-Friday,
8 AM-6:30 PM CT
Fax: 1-888-752-7626
https://connect.
mckesson.com
Morris & Dickson Specialty 1-800-710-6100 Fax: 1-318-524-3096
https://www.mdspecialtydist.com

Puerto Rico Hospitals and Clinics

Authorized Distributor Phone Orders Fax Orders and Website
AmerisourceBergen Puerto Rico 1-844-222-2273 https://abcorder.amerisourcebergen.com

Above information is accurate as of 11/21.

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 adjuvant treatment of completely resected esophageal or gastroesophageal junction cancer with residual pathologic disease in patients who have received neoadjuvant chemoradiotherapy (CRT) – Approved on 05/20/2021

View Letter

Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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. Centers for Medicare & Medicaid Services. ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-CM. Accessed September 1, 2021.

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 03/22.

1506-US-2101816 03/22