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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)

J9228

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Injection, ipilimumab, 1 mg

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,†

OPDIVO

96413

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

YERVOY

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)

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

00003-3756-14

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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

YERVOY

00003-2327-11

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

00003-2328-22

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

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 and YERVOY^® (ipilimumab) 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 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	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

Above information is accurate as of 09/21.

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.

FDA Approval Letter as Posted by the FDA:

OPDIVO in combination with YERVOY^® (ipilimumab) for adults and pediatric patients 12 years and older with MSI-H/dMMR metastatic colorectal cancer that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan – Approved on 07/10/2018

View Letter

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

View Letter

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

dMMR=mismatch repair deficient; MSI-H=microsatellite instability high.

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.

*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.
YERVOY [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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