Billing and
Diagnosis Codes
Advanced Renal Cell Carcinoma (aRCC) 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.
BMS Access Support provides coding and distribution information for only Bristol Myers Squibb products.
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
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
COPY
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
COPY
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)
COPY
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)
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
One 50-mg vial (5 mg/mL), single-dose vial
COPY
One 200-mg vial (5 mg/mL), single-dose vial
COPY
Malignant neoplasm of kidney, except renal pelvis
Malignant neoplasm of right kidney, except renal pelvis
COPY
Malignant neoplasm of left kidney, except renal pelvis
COPY
Malignant neoplasm of unspecified kidney, except renal pelvis
COPY
Malignant neoplasm of renal pelvis
COPY
Malignant neoplasm of right renal pelvis
COPY
Malignant neoplasm of left renal pelvis
COPY
Malignant neoplasm of unspecified renal pelvis
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 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 |
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 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 Letters as Posted by the FDA:
OPDIVO in combination with YERVOY® (ipilimumab) for the first-line treatment of patients with intermediate or poor risk, advanced RCC – Approved on 04/16/2018
OPDIVO in combination with cabozantinib for the first-line treatment of patients with advanced renal cell carcinoma (RCC) – Approved on 01/22/2021
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
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.