Billing and
Diagnosis Codes
Unresectable or Metastatic Melanoma (mMelanoma) and Adjuvant Treatment of Melanoma (Adj Tx of Melanoma) Monotherapy
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
Download
- Codes*
- Distribution
- FDA Letters
COPY
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
COPY
Drugs requiring detailed coding
COPY
Chemotherapy administration, IV
COPY
IV Therapy-General
COPY
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.
COPY
40 mg/4 mL (10 mg/mL) single-dose vial
COPY
100 mg/10 mL (10 mg/mL) single-dose vial
COPY
120 mg/12 mL (10 mg/mL) single-dose vial
COPY
240 mg/24 mL (10 mg/mL) single-dose vial
COPY
Malignant melanoma of skin
COPY
Malignant melanoma of lip
COPY
Malignant melanoma of eyelid, including canthus
COPY
Malignant melanoma of unspecified eyelid, including canthus
COPY
Malignant melanoma of right eyelid, including canthus
COPY
Malignant melanoma of right upper eyelid, including canthus
COPY
Malignant melanoma of right lower eyelid, including canthus
COPY
Malignant melanoma of left eyelid, including canthus
COPY
Malignant melanoma of left upper eyelid, including canthus
COPY
Malignant melanoma of left lower eyelid, including canthus
COPY
Malignant melanoma of ear and external auricular canal
COPY
Malignant melanoma of unspecified ear and external auricular canal
COPY
Malignant melanoma of right ear and external auricular canal
COPY
Malignant melanoma of left ear and external auricular canal
COPY
Malignant melanoma of other and unspecified parts of face
COPY
Malignant melanoma of unspecified part of face
COPY
Malignant melanoma of nose
COPY
Malignant melanoma of other parts of face
COPY
Malignant melanoma of scalp and neck
COPY
Malignant melanoma of trunk
COPY
Malignant melanoma of anal skin
COPY
Malignant melanoma of skin of breast
COPY
Malignant melanoma of other part of trunk
COPY
Malignant melanoma of upper limb, including shoulder
COPY
Malignant melanoma of unspecified upper limb, including shoulder
COPY
Malignant melanoma of right upper limb, including shoulder
COPY
Malignant melanoma of left upper limb, including shoulder
COPY
Malignant melanoma of lower limb, including hip
COPY
Malignant melanoma of unspecified lower limb, including hip
COPY
Malignant melanoma of right lower limb, including hip
COPY
Malignant melanoma of left lower limb, including hip
COPY
Malignant melanoma of overlapping sites of skin
COPY
Malignant melanoma of skin, unspecified
COPY
Malignant neoplasm of anus and anal canal
COPY
Malignant neoplasm of anus, unspecified
COPY
Malignant neoplasm of anal canal
COPY
Malignant neoplasm of vulva
COPY
Malignant neoplasm of labium majus
COPY
Malignant neoplasm of labium minus
COPY
Malignant neoplasm of clitoris
COPY
Malignant neoplasm of vulva, unspecified
COPY
Malignant neoplasm of vagina
COPY
Malignant neoplasm of other and unspecified female genital organs
COPY
Malignant neoplasm of other specified female genital organs
COPY
Malignant neoplasm of overlapping sites of female genital organs
COPY
Malignant neoplasm of female genital organ, unspecified
COPY
Malignant neoplasm of penis
COPY
Malignant neoplasm of prepuce
COPY
Malignant neoplasm of glans penis
COPY
Malignant neoplasm of overlapping sites of penis
COPY
Malignant neoplasm of penis, unspecified
COPY
Malignant neoplasm of other and unspecified male genital organs
COPY
Malignant neoplasm of epididymis
COPY
Malignant neoplasm of unspecified epididymis
COPY
Malignant neoplasm of right epididymis
COPY
Malignant neoplasm of left epididymis
COPY
Malignant neoplasm of spermatic cord
COPY
Malignant neoplasm of unspecified spermatic cord
COPY
Malignant neoplasm of right spermatic cord
COPY
Malignant neoplasm of left spermatic cord
COPY
Malignant neoplasm of scrotum
COPY
Malignant neoplasm of other specified male genital organs
COPY
Malignant neoplasm of overlapping sites of male genital organs
COPY
Malignant neoplasm of male genital organ, unspecified
COPY
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 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 11/21.
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.
Unresectable or Metastatic Melanoma
FDA Approval Letters as Posted by the FDA:
OPDIVO for the treatment of patients with unresectable or metastatic melanoma (indication simplification) - Approved on 03/07/2019
View LetterFlat Dosing for OPDIVO (240 mg every 2 weeks) - Approved on 09/13/2016
View LetterFlat Dosing for OPDIVO (480 mg every 4 weeks) - Approved on 03/05/2018
View LetterAvailability of OPDIVO 120 mg vial – Approved on 08/27/2021
Adjuvant Treatment of Melanoma
FDA Approval Letters as Posted by the FDA:
OPDIVO for the adjuvant treatment of patients with melanoma with involvement of lymph nodes or metastatic disease who have undergone complete resection - Approved on 12/20/2017
View LetterFlat Dosing for OPDIVO (240 mg every 2 weeks, or 480 mg every 4 weeks) - Approved on 03/05/2018
View LetterAvailability 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.