Billing and
Diagnosis Codes
Locally Advanced or Metastatic Urothelial Carcinoma (UC)
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 renal pelvis
Malignant neoplasm of the right renal pelvis
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Malignant neoplasm of the left renal pelvis
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Malignant neoplasm of unspecified renal pelvis
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Malignant neoplasm of ureter
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Malignant neoplasm of the right ureter
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Malignant neoplasm of the left ureter
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Malignant neoplasm of unspecified ureter
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Malignant neoplasm of bladder
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Malignant neoplasm of trigone of bladder
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Malignant neoplasm of dome of bladder
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Malignant neoplasm of lateral wall of bladder
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Malignant neoplasm of anterior wall of bladder
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Malignant neoplasm of posterior wall of bladder
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Malignant neoplasm of bladder neck
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Malignant neoplasm of ureteric orifice
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Malignant neoplasm of overlapping sites of bladder
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Malignant neoplasm of bladder, unspecified
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Malignant neoplasm of other and unspecified urinary organs
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Malignant neoplasm of urethra
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Malignant neoplasm of overlapping sites of urinary organs
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Malignant neoplasm of urinary organ, unspecified
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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://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 |
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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://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 |
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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 the treatment of patients with locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or have disease progression within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy – Approved on 02/02/2017
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.