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Neoadjuvant Treatment of Resectable Non-Small Cell Lung Cancer (NeoAdj Tx of NSCLC) and Metastatic Non-Small Cell Lung Cancer (mNSCLC) Combination Therapy

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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

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

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

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

00003-2328-22

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

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

C33

Malignant neoplasm of trachea

C34

Malignant neoplasm of bronchus and lung

C34.0

Malignant neoplasm of main bronchus, carina, and hilus of lung

C34.00

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Malignant neoplasm of unspecified main bronchus

C34.01

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Malignant neoplasm of right main bronchus

C34.02

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Malignant neoplasm of left main bronchus

C34.1

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Malignant neoplasm of upper lobe, bronchus or lung

C34.10

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Malignant neoplasm of upper lobe, unspecified bronchus or lung

C34.11

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Malignant neoplasm of upper lobe, right bronchus or lung

C34.12

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Malignant neoplasm of upper lobe, left bronchus or lung

C34.2

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Malignant neoplasm of middle lobe, bronchus or lung

C34.3

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Malignant neoplasm of lower lobe, bronchus or lung

C34.30

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Malignant neoplasm of lower lobe, unspecified bronchus or lung

C34.31

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Malignant neoplasm of lower lobe, right bronchus or lung

C34.32

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Malignant neoplasm of lower lobe, left bronchus or lung

C34.8

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Malignant neoplasm of overlapping sites of bronchus and lung

C34.80

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Malignant neoplasm of overlapping sites of unspecified bronchus and lung

C34.81

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Malignant neoplasm of overlapping sites of right bronchus and lung

C34.82

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Malignant neoplasm of overlapping sites of left bronchus and lung

C34.9

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Malignant neoplasm of unspecified part of bronchus or lung

C34.90

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Malignant neoplasm of unspecified part of bronchus or lung

C34.91

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Malignant neoplasm of unspecified part of right bronchus or lung

C34.92

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Malignant neoplasm of unspecified part of left bronchus or lung

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	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 https://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 03/22.

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.

Metastatic Non-Small Cell Lung Cancer

FDA Approval Letters as Posted by the FDA:

OPDIVO in combination with YERVOY^® (ipilimumab) for the first-line treatment of adult patients with metastatic non-small cell lung cancer whose tumors express PD-L1 (≥1%) as determined by an FDA-approved test, with no EGFR or ALK genomic tumor aberrations – Approved on 05/15/2020

View Letter

OPDIVO, in combination with YERVOY and 2 cycles of platinum-doublet chemotherapy, for the first-line treatment of adult patients with metastatic or recurrent non-small cell lung cancer, with no EGFR or ALK genomic tumor aberrations – Approved on 05/26/2020

View Letter

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

View Letter

Neoadjuvant Treatment of Resectable Non-Small Cell Lung Cancer

FDA Approval Letter as Posted by the FDA:

OPDIVO, in combination with platinum-doublet chemotherapy, for neoadjuvant treatment of adult patients with resectable (tumors ≥ 4cm or node positive) non-small cell lung cancer – Approved on 03/04/2022

View Letter

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

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 February 22, 2022.
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 February 22, 2022.
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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