Billing and
Diagnosis Codes
Metastatic Non-Small Cell Lung Cancer (mNSCLC) 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
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- Codes*
- Distribution
- FDA Letters
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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
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Drugs requiring detailed coding
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Chemotherapy administration, IV
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IV Therapy-General
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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.
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40 mg/4 mL (10 mg/mL) single-dose vial
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100 mg/10 mL (10 mg/mL) single-dose vial
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120 mg/12 mL (10 mg/mL) single-dose vial
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240 mg/24 mL (10 mg/mL) single-dose vial
Malignant neoplasm of trachea
Malignant neoplasm of bronchus and lung
Malignant neoplasm of main bronchus, carina, and hilus of lung
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Malignant neoplasm of unspecified main bronchus
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Malignant neoplasm of right main bronchus
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Malignant neoplasm of left main bronchus
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Malignant neoplasm of upper lobe, bronchus or lung
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Malignant neoplasm of upper lobe, unspecified bronchus or lung
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Malignant neoplasm of upper lobe, right bronchus or lung
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Malignant neoplasm of upper lobe, left bronchus or lung
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Malignant neoplasm of middle lobe, bronchus or lung
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Malignant neoplasm of lower lobe, bronchus or lung
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Malignant neoplasm of lower lobe, unspecified bronchus or lung
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Malignant neoplasm of lower lobe, right bronchus or lung
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Malignant neoplasm of lower lobe, left bronchus or lung
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Malignant neoplasm of overlapping sites of bronchus and lung
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Malignant neoplasm of overlapping sites of unspecified bronchus and lung
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Malignant neoplasm of overlapping sites of right bronchus and lung
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Malignant neoplasm of overlapping sites of left bronchus and lung
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Malignant neoplasm of unspecified part of bronchus or lung
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Malignant neoplasm of unspecified part of bronchus or lung
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Malignant neoplasm of unspecified part of right bronchus or lung
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Malignant neoplasm of unspecified part of left bronchus or lung
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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 may be purchased through the distributors listed below.
Physician Offices
Specialty Distributor | Phone Orders | Fax Orders and Website |
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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://specialtyonline.cardinalhealth.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 |
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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://orderexpress.cardinalhealth.com |
DMS Pharmaceutical Group, Inc. | 1-877-788-1100 Monday-Friday, 8:30 AM-5 PM CT |
Fax: 1-847-518-1105 www.dmspharma.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 |
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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.
FDA Approval Letters as Posted by the FDA:
OPDIVO for patients with metastatic non-squamous NSCLC who have progression on or after platinum-based chemotherapy* - Approved on 10/09/2015
OPDIVO for patients with metastatic squamous NSCLC who have progression on or after platinum-based chemotherapy* - Approved on 03/04/2015
Flat Dosing for OPDIVO (240 mg every 2 weeks) - Approved on 09/13/2016
Flat Dosing for OPDIVO (480 mg every 4 weeks) - Approved on 03/05/2018
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
*Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving OPDIVO.
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.