Billing and
Diagnosis Codes
Classical Hodgkin Lymphoma (cHL)
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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- Codes*
- Distribution
- FDA Letters
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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
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Drugs requiring detailed coding
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Chemotherapy administration, IV
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IV Therapy-General
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Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
Note:Payers require the submission of the 11-digit NDC on healthcare claim forms. Please use the 11-digit codes shown here.
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40 mg/4 mL (10 mg/mL) single-dose vial
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100 mg/10 mL (10 mg/mL) single-dose vial
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120 mg/12 mL (10 mg/mL) single-dose vial
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240 mg/24 mL (10 mg/mL) single-dose vial
Hodgkin lymphoma
Nodular sclerosis Hodgkin lymphoma
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Nodular sclerosis Hodgkin lymphoma, unspecified site
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Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck
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Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes
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Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes
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Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb
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Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
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Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes
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Nodular sclerosis Hodgkin lymphoma, spleen
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Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites
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Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites
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Mixed cellularity Hodgkin lymphoma
Mixed cellularity Hodgkin lymphoma, unspecified site
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Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck
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Mixed cellularity Hodgkin lymphoma, intrathoracic lymph nodes
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Mixed cellularity Hodgkin lymphoma, intra-abdominal lymph nodes
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Mixed cellularity Hodgkin lymphoma, lymph nodes of axilla and upper limb
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Mixed cellularity Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
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Mixed cellularity Hodgkin lymphoma, intrapelvic lymph nodes
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Mixed cellularity Hodgkin lymphoma, spleen
Mixed cellularity Hodgkin lymphoma, lymph nodes of multiple sites
Mixed cellularity Hodgkin lymphoma, extranodal and solid organ sites
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Lymphocyte-depleted Hodgkin lymphoma
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Lymphocyte-depleted Hodgkin lymphoma, unspecified site
Lymphocyte-depleted Hodgkin lymphoma, lymph nodes of head, face, and neck
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Lymphocyte-depleted Hodgkin lymphoma, intrathoracic lymph nodes
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Lymphocyte-depleted Hodgkin lymphoma, intra-abdominal lymph nodes
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Lymphocyte-depleted Hodgkin lymphoma, lymph nodes of axilla and upper limb
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Lymphocyte-depleted Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
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Lymphocyte-depleted Hodgkin lymphoma, intrapelvic lymph nodes
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Lymphocyte-depleted Hodgkin lymphoma, spleen
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Lymphocyte-depleted Hodgkin lymphoma, lymph nodes of multiple sites
Lymphocyte-depleted Hodgkin lymphoma, extranodal and solid organ sites
Lymphocyte-rich Hodgkin lymphoma
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Lymphocyte-rich Hodgkin lymphoma, unspecified site
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Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck
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Lymphocyte-rich Hodgkin lymphoma, intrathoracic lymph nodes
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Lymphocyte-rich Hodgkin lymphoma, intra-abdominal lymph nodes
Lymphocyte-rich Hodgkin lymphoma, lymph nodes of axilla and upper limb
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Lymphocyte-rich Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
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Lymphocyte-rich Hodgkin lymphoma, intrapelvic lymph nodes
Lymphocyte-rich Hodgkin lymphoma, spleen
Lymphocyte-rich Hodgkin lymphoma, lymph nodes of multiple sites
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Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites
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Other Hodgkin lymphoma
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Other Hodgkin lymphoma, unspecified site
Other Hodgkin lymphoma, lymph nodes of head, face, and neck
Other Hodgkin lymphoma, intrathoracic lymph nodes
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Other Hodgkin lymphoma, intra-abdominal lymph nodes
Other Hodgkin lymphoma, lymph nodes of axilla and upper limb
Other Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
Other Hodgkin lymphoma, intrapelvic lymph nodes
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Other Hodgkin lymphoma, spleen
Other Hodgkin lymphoma, lymph nodes of multiple sites
Other Hodgkin lymphoma, extranodal and solid organ sites
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.
Stem cell transplant status
For patients who have had a stem cell transplant, add "Z94.84" as a secondary code.
OPDIVO may be purchased through the distributors listed below.
Physician Offices
Specialty Distributor | Phone Orders | Fax Orders and Website |
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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 |
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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 |
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AmerisourceBergen Puerto Rico | 1-844-222-2273 | https://abcorder.amerisourcebergen.com |
Above information is accurate as of 09/21.
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 treatment of adult patients with classical Hodgkin lymphoma (cHL) that has relapsed or progressed after autologous hematopoietic stem cell transplantation (HSCT) and brentuximab vedotin or after 3 or more lines of systemic therapy that includes autologous HSCT – Approved on 04/28/2017
OPDIVO for the treatment of patients with cHL that has relapsed or progressed after autologous HSCT and post-transplantation brentuximab vedotin- Approved on 5/17/2016
Flat Dosing for OPDIVO (240 mg every 2 weeks) – Approved on 02/15/2018
Flat Dosing for OPDIVO (480 mg every 4 weeks) – Approved on 03/05/2018
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
Please see U.S. Full Prescribing Information for OPDIVO for complete indications.
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.