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

Metastatic Colorectal Cancer (mCRC) Combination Therapy

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
OPDIVO
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

YERVOY® (ipilimumab)

In combination with OPDIVO for the treatment of adults and pediatric patients 12 years and older with microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) metastatic colorectal cancer (CRC) that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan

J9228

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Injection, ipilimumab, 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,†
OPDIVO
96413

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Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug

YERVOY

In combination with OPDIVO for the treatment of adults and pediatric patients 12 years and older with microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) metastatic colorectal cancer (CRC) that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan

96417

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Chemotherapy administration, IV infusion; each additional sequential infusion (different substance/drug), up to 1 hour (list separately in addition to code for primary procedure). (Use 96417 in conjunction with 96413)

96415

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Chemotherapy administration, IV infusion; each additional hour (list separately in addition to code for primary procedure). (Report 96415 for infusion intervals of greater than 30 minutes beyond 1-hour increments)

MSI/MMR CPT Testing Codes4
88342

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Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure

+88341

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Each additional single antibody stain procedure

81301

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Microsatellite instability analysis

National Drug Codes (NDC)5,6 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.

OPDIVO
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

YERVOY

In combination with OPDIVO for the treatment of adults and pediatric patients 12 years and older with microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) metastatic colorectal cancer (CRC) that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan

00003-2327-11

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One 50-mg vial (5 mg/mL), single-use vial

00003-2328-22

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One 200-mg vial (5 mg/mL), single-use vial

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)7
C18

Malignant neoplasm of colon

C18.0

Malignant neoplasm of cecum

C18.1

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Malignant neoplasm of appendix

C18.2

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Malignant neoplasm of ascending colon

C18.3

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Malignant neoplasm of hepatic flexure

C18.4

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Malignant neoplasm of transverse colon

C18.5

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Malignant neoplasm of splenic flexure

C18.6

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Malignant neoplasm of descending colon

C18.7

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Malignant neoplasm of sigmoid colon

C18.8

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Malignant neoplasm of overlapping sites of colon

C18.9

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Malignant neoplasm of colon, unspecified

C19

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Malignant neoplasm of rectosigmoid junction

C20

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Malignant neoplasm of rectum

Coding for OPDIVO and YERVOY 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 and YERVOY, including Boxed WARNING for YERVOY regarding immune-mediated adverse reactions.

*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. YERVOY [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  7. American Medical Association. 2019 ICD-10-CM: The Complete Official Codebook. Chicago, IL: American Medical Association; 2018.

OPDIVO and YERVOY® (ipilimumab) 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 and YERVOY 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 09/19.

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

Please see U.S. Full Prescribing Information for OPDIVO and YERVOY, including Boxed WARNING for YERVOY regarding immune-mediated adverse reactions.

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 09/19.

1506US1804747-02-01 09/19