Billing and
Diagnosis Codes
Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck (SCCHN)
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
Malignant neoplasm of lip
Malignant neoplasm of external upper lip
COPY
Malignant neoplasm of external lower lip
COPY
Malignant neoplasm of external lip, unspecified
Malignant neoplasm of upper lip, inner aspect
COPY
Malignant neoplasm of lower lip, inner aspect
COPY
Malignant neoplasm of lip, unspecified, inner aspect
COPY
Malignant neoplasm of commissure of lip, unspecified
COPY
Malignant neoplasm of overlapping sites of lip
COPY
Malignant neoplasm of lip, unspecified
COPY
Malignant neoplasm of base of tongue
COPY
Malignant neoplasm of other and unspecified parts of tongue
COPY
Malignant neoplasm of dorsal surface of tongue
COPY
Malignant neoplasm of border of tongue
COPY
Malignant neoplasm of ventral surface of tongue
COPY
Malignant neoplasm of anterior two-thirds of tongue, part unspecified
COPY
Malignant neoplasm of lingual tonsil
COPY
Malignant neoplasm of overlapping sites of tongue
COPY
Malignant neoplasm of tongue, unspecified
COPY
Malignant neoplasm of gum
COPY
Malignant neoplasm of upper gum
COPY
Malignant neoplasm of lower gum
COPY
Malignant neoplasm of gum, unspecified
COPY
Malignant neoplasm of floor of mouth
COPY
Malignant neoplasm of anterior floor of mouth
COPY
Malignant neoplasm of lateral floor of mouth
COPY
Malignant neoplasm of overlapping sites of floor of mouth
COPY
Malignant neoplasm of floor of mouth, unspecified
COPY
Malignant neoplasm of palate
COPY
Malignant neoplasm of hard palate
COPY
Malignant neoplasm of soft palate
COPY
Malignant neoplasm of uvula
COPY
Malignant neoplasm of overlapping sites of palate
COPY
Malignant neoplasm of palate, unspecified
COPY
Malignant neoplasm of other and unspecified parts of mouth
COPY
Malignant neoplasm of cheek mucosa
COPY
Malignant neoplasm of vestibule of mouth
COPY
Malignant neoplasm of retromolar area
COPY
Malignant neoplasm of overlapping sites of other and unspecified parts of mouth
COPY
Malignant neoplasm of overlapping sites of unspecified parts of mouth
COPY
Malignant neoplasm of overlapping sites of other parts of mouth
COPY
Malignant neoplasm of mouth, unspecified
COPY
Malignant neoplasm of tonsil
COPY
Malignant neoplasm of tonsillar fossa
COPY
Malignant neoplasm of tonsillar pillar (anterior) (posterior)
COPY
Malignant neoplasm of overlapping sites of tonsil
COPY
Malignant neoplasm of tonsil, unspecified
COPY
Malignant neoplasm of oropharynx
COPY
Malignant neoplasm of vallecula
COPY
Malignant neoplasm of anterior surface of epiglottis
COPY
Malignant neoplasm of lateral wall of oropharynx
COPY
Malignant neoplasm of posterior wall of oropharynx
COPY
Malignant neoplasm of branchial cleft
COPY
Malignant neoplasm of overlapping sites of oropharynx
COPY
Malignant neoplasm of pyriform sinus
COPY
Malignant neoplasm of hypopharynx
COPY
Malignant neoplasm of postcricoid region
COPY
Malignant neoplasm aryepiglottic fold, hypopharyngeal aspect
COPY
Malignant neoplasm of posterior wall of hypopharynx
COPY
Malignant neoplasm of overlapping sites of hypopharynx
COPY
Malignant neoplasm of hypopharynx, unspecified
COPY
Malignant neoplasm of other and ill-defined sites in the lip, oral cavity and pharynx
COPY
Malignant neoplasm of pharynx, unspecified
COPY
Malignant neoplasm of Waldeyer’s ring
COPY
Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx
COPY
Malignant neoplasm of larynx
COPY
Malignant neoplasm of glottis
COPY
Malignant neoplasm of supraglottis
COPY
Malignant neoplasm of subglottis
COPY
Malignant neoplasm of laryngeal cartilage
COPY
Malignant neoplasm of overlapping sites of larynx
COPY
Malignant neoplasm of larynx, unspecified
COPY
Malignant neoplasm of other and ill-defined sites
COPY
Malignant neoplasm of head, face and neck
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.
FDA Approval Letters as Posted by the FDA:
OPDIVO for patients with recurrent or metastatic squamous cell carcinoma of the head and neck with disease progression on or after platinum-based therapy - Approved on 11/10/2016
Flat Dosing for OPDIVO (240 mg every 2 weeks) - Approved on 02/15/2018
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
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.