Billing and
Diagnosis Codes
Unresectable Advanced or Metastatic Esophageal Squamous Cell Carcinoma (ESCC) 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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- Codes*
- Distribution
- FDA Letters
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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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
Drugs requiring detailed coding
Chemotherapy administration, IV
IV Therapy-General
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
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)
Note:Payers require the submission of the 11-digit NDC on healthcare claim forms. Please use the 11-digit codes shown here.
40 mg/4 mL (10 mg/mL) single-dose vial
100 mg/10 mL (10 mg/mL) single-dose vial
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120 mg/12 mL (10 mg/mL) single-dose vial
240 mg/24 mL (10 mg/mL) single-dose vial
50 mg/10 mL (5 mg/mL) single-dose vial
200 mg/40 mL (5 mg/mL) single-dose vial
Malignant neoplasm of esophagus
Malignant neoplasm of upper third of esophagus
Malignant neoplasm of middle third of esophagus
Malignant neoplasm of lower third of esophagus
Malignant neoplasm of overlapping sites of esophagus
Malignant neoplasm of esophagus, unspecified
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 | https://www.besse.com |
Cardinal Health Specialty Pharmaceutical Distribution | 1-877-453-3972 | https://specialtyonline.cardinalhealth.com |
CuraScript Specialty Distribution | 1-877-599-7748 | https://www.curascriptsd.com |
McKesson Specialty Health | 1-800-482-6700 | https://mscs.mckesson.com |
Morris & Dickson Specialty | 1-800-710-6100 | Fax: 1-318-524-3096 https://www.mdspecialtydist.com |
Oncology Supply | 1-800-633-7555 | 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 | Fax: 1-800-547-9413 https://www. asdhealthcare.com |
Cardinal Health Specialty Pharmaceutical Distribution | 1-866-677-4844 | Fax: 1-614-553-6301 https://orderexpress.cardinalhealth.com |
DMS Pharmaceutical Group, Inc. | 1-877-788-1100 | Fax: 1-847-518-1105 www.dmspharma.com |
McKesson Plasma and Biologics | 1-877-625-2566 | 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 |
---|---|---|
Cardinal Puerto Rico (Borschow) | 1-787-625-4200 | https://orderexpress.cardinalhealth.com |
Cesar Castillo, Inc. | 1-787-641-5242 (Hospitals) 1-787-641-5082 (Specialty Pharmacies) |
Fax: 1-787-999-1614 https://www.facilfarmaciacci.com |
AmerisourceBergen Puerto Rico | 1-844-222-2273 | https://abcorder.amerisourcebergen.com |
Above information is accurate as of 05/22.
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 for complete indications.
FDA Approval Letters as Posted by the FDA:
OPDIVO, in combination with YERVOY® (ipilimumab), for the first-line treatment of adult patients with unresectable advanced or metastatic esophageal squamous cell carcinoma (ESCC) – Approved on 05/27/2022
OPDIVO, in combination with fluoropyrimidine- and platinum-containing chemotherapy, for the first-line treatment of adult patients with unresectable advanced or metastatic esophageal squamous cell carcinoma (ESCC) – Approved on 05/27/2022
Please see U.S. Full Prescribing Information for OPDIVO and YERVOY 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.