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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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

00003-3756-14

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120 mg/12 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

C81

Hodgkin lymphoma

C81.1

Nodular sclerosis Hodgkin lymphoma

C81.10

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Nodular sclerosis Hodgkin lymphoma, unspecified site

C81.11

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Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck

C81.12

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Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes

C81.13

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Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes

C81.14

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Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb

C81.15

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Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb

C81.16

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Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes

C81.17

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Nodular sclerosis Hodgkin lymphoma, spleen

C81.18

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Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites

C81.19

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Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites

C81.2

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Mixed cellularity Hodgkin lymphoma

C81.20

Mixed cellularity Hodgkin lymphoma, unspecified site

C81.21

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Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck

C81.22

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Mixed cellularity Hodgkin lymphoma, intrathoracic lymph nodes

C81.23

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Mixed cellularity Hodgkin lymphoma, intra-abdominal lymph nodes

C81.24

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Mixed cellularity Hodgkin lymphoma, lymph nodes of axilla and upper limb

C81.25

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Mixed cellularity Hodgkin lymphoma, lymph nodes of inguinal region and lower limb

C81.26

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Mixed cellularity Hodgkin lymphoma, intrapelvic lymph nodes

C81.27

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Mixed cellularity Hodgkin lymphoma, spleen

C81.28

Mixed cellularity Hodgkin lymphoma, lymph nodes of multiple sites

C81.29

Mixed cellularity Hodgkin lymphoma, extranodal and solid organ sites

C81.3

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Lymphocyte-depleted Hodgkin lymphoma

C81.30

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Lymphocyte-depleted Hodgkin lymphoma, unspecified site

C81.31

Lymphocyte-depleted Hodgkin lymphoma, lymph nodes of head, face, and neck

C81.32

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Lymphocyte-depleted Hodgkin lymphoma, intrathoracic lymph nodes

C81.33

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Lymphocyte-depleted Hodgkin lymphoma, intra-abdominal lymph nodes

C81.34

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Lymphocyte-depleted Hodgkin lymphoma, lymph nodes of axilla and upper limb

C81.35

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Lymphocyte-depleted Hodgkin lymphoma, lymph nodes of inguinal region and lower limb

C81.36

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Lymphocyte-depleted Hodgkin lymphoma, intrapelvic lymph nodes

C81.37

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Lymphocyte-depleted Hodgkin lymphoma, spleen

C81.38

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Lymphocyte-depleted Hodgkin lymphoma, lymph nodes of multiple sites

C81.39

Lymphocyte-depleted Hodgkin lymphoma, extranodal and solid organ sites

C81.4

Lymphocyte-rich Hodgkin lymphoma

C81.40

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Lymphocyte-rich Hodgkin lymphoma, unspecified site

C81.41

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Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck

C81.42

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Lymphocyte-rich Hodgkin lymphoma, intrathoracic lymph nodes

C81.43

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Lymphocyte-rich Hodgkin lymphoma, intra-abdominal lymph nodes

C81.44

Lymphocyte-rich Hodgkin lymphoma, lymph nodes of axilla and upper limb

C81.45

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Lymphocyte-rich Hodgkin lymphoma, lymph nodes of inguinal region and lower limb

C81.46

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Lymphocyte-rich Hodgkin lymphoma, intrapelvic lymph nodes

C81.47

Lymphocyte-rich Hodgkin lymphoma, spleen

C81.48

Lymphocyte-rich Hodgkin lymphoma, lymph nodes of multiple sites

C81.49

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Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites

C81.7

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Other Hodgkin lymphoma

C81.70

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Other Hodgkin lymphoma, unspecified site

C81.71

Other Hodgkin lymphoma, lymph nodes of head, face, and neck

C81.72

Other Hodgkin lymphoma, intrathoracic lymph nodes

C81.73

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Other Hodgkin lymphoma, intra-abdominal lymph nodes

C81.74

Other Hodgkin lymphoma, lymph nodes of axilla and upper limb

C81.75

Other Hodgkin lymphoma, lymph nodes of inguinal region and lower limb

C81.76

Other Hodgkin lymphoma, intrapelvic lymph nodes

C81.77

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Other Hodgkin lymphoma, spleen

C81.78

Other Hodgkin lymphoma, lymph nodes of multiple sites

C81.79

Other Hodgkin lymphoma, extranodal and solid organ sites

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.

Z94.84

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
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 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

View Letter

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

View Letter

Flat Dosing for OPDIVO (240 mg every 2 weeks) – Approved on 02/15/2018

View Letter

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

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:

American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
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.
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.
American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
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.

OPDIVO^® (nivolumab)

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Billing and Diagnosis Codes

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