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ORENCIA® (abatacept)

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Billing and
Diagnosis Codes

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 ORENCIA
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  • Codes*
  • FDA Letters


Filter by keyword Clear Filter
Link to HCPCS, CPT, NDC, codes for ORENCIA or ICD-10 codes for: RA, JIA, PsA
Healthcare Common Procedure Coding System (HCPCS) Codes1 Issued by CMS
J0129

Injection, abatacept, 10 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

Current Procedural Terminology (CPT)3,†^  Back to Top
Intravenous Use Only
96413

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Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug

96365

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Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour

Subcutaneous Injection Only
96372

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Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

National Drug Codes (NDC)4 ^  Back to TopIssued 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.

For patients with moderate to severe polyarticular juvenile idiopathic arthritis (pJIA), ORENCIA may be administered as an intravenous infusion (6 years of age and older) or a subcutaneous injection (2 years of age and older). Intravenous dosing has not been studied in patients younger than 6 years of age. PJIA patients may self-inject with ORENCIA or the patient’s caregiver may administer ORENCIA if both the healthcare practitioner and the parent/legal guardian determines it is appropriate. The ability of pediatric patients to self-inject with the autoinjector has not been tested.

Intravenous Use Only
00003-2187-10

COPY

250 mg in a 15-mL single-use vial, in a clamshell presentation

00003-2187-13

COPY

250 mg in a 15-mL single-use vial, in a carton presentation

Subcutaneous Injection Only
00003-2814-11

COPY

Pack of 4 syringes with a passive needle safety guard (50 mg/0.4 mL pre-filled syringe)

00003-2818-11

COPY

Pack of 4 syringes with a passive needle safety guard (87.5 mg/0.7 mL pre-filled syringe)

00003-2188-11

COPY

Pack of 4 syringes with a passive needle safety guard (125 mg/1 mL pre-filled syringe)

00003-2188-51

COPY

Pack of 4 single-dose autoinjectors (125 mg/1 mL)

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)5 ^  Back to Top
Adult Rheumatoid Arthritis
M05.7

Rheumatoid arthritis with rheumatoid factor without organ or systems involvement

M05.70

COPY

Rheumatoid arthritis with rheumatoid factor of unspecified site without organ or systems involvement

M05.71

COPY

Rheumatoid arthritis with rheumatoid factor of shoulder without organ or systems involvement

M05.711

COPY

Rheumatoid arthritis with rheumatoid factor of right shoulder without organ or systems involvement

M05.712

COPY

Rheumatoid arthritis with rheumatoid factor of left shoulder without organ or systems involvement

M05.719

COPY

Rheumatoid arthritis with rheumatoid factor of unspecified shoulder without organ or systems involvement

M05.72

COPY

Rheumatoid arthritis with rheumatoid factor of elbow without organ or systems involvement

M05.721

COPY

Rheumatoid arthritis with rheumatoid factor of right elbow without organ or systems involvement

M05.722

COPY

Rheumatoid arthritis with rheumatoid factor of left elbow without organ or systems involvement

M05.729

COPY

Rheumatoid arthritis with rheumatoid factor of unspecified elbow without organ or systems involvement

M05.73

COPY

Rheumatoid arthritis with rheumatoid factor of wrist without organ or systems involvement

M05.731

COPY

Rheumatoid arthritis with rheumatoid factor of right wrist without organ or systems involvement

M05.732

COPY

Rheumatoid arthritis with rheumatoid factor of left wrist without organ or systems involvement

M05.739

COPY

Rheumatoid arthritis with rheumatoid factor of unspecified wrist without organ or systems involvement

M05.74

COPY

Rheumatoid arthritis with rheumatoid factor of hand without organ or systems involvement

M05.741

COPY

Rheumatoid arthritis with rheumatoid factor of right hand without organ or systems involvement

M05.742

COPY

Rheumatoid arthritis with rheumatoid factor of left hand without organ or systems involvement

M05.749

COPY

Rheumatoid arthritis with rheumatoid factor of unspecified hand without organ or systems involvement

M05.75

COPY

Rheumatoid arthritis with rheumatoid factor of hip without organ or systems involvement

M05.751

COPY

Rheumatoid arthritis with rheumatoid factor of right hip without organ or systems involvement

M05.752

COPY

Rheumatoid arthritis with rheumatoid factor of left hip without organ or systems involvement

M05.759

COPY

Rheumatoid arthritis with rheumatoid factor of unspecified hip without organ or systems involvement

M05.76

COPY

Rheumatoid arthritis with rheumatoid factor of knee without organ or systems involvement

M05.761

COPY

Rheumatoid arthritis with rheumatoid factor of right knee without organ or systems involvement

M05.762

COPY

Rheumatoid arthritis with rheumatoid factor of left knee without organ or systems involvement

M05.769

COPY

Rheumatoid arthritis with rheumatoid factor of unspecified knee without organ or systems involvement

M05.77

COPY

Rheumatoid arthritis with rheumatoid factor of ankle and foot without organ or systems involvement

M05.771

COPY

Rheumatoid arthritis with rheumatoid factor of right ankle and foot without organ or systems involvement

M05.772

COPY

Rheumatoid arthritis with rheumatoid factor of left ankle and foot without organ or systems involvement

M05.779

COPY

Rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot without organ or systems involvement

M05.79

COPY

Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement

M05.7A

COPY

Rheumatoid arthritis with rheumatoid factor of other specified site without organ or systems involvement

M05.8

COPY

Other rheumatoid arthritis with rheumatoid factor

M05.80

COPY

Other rheumatoid arthritis with rheumatoid factor of unspecified site

M05.81

COPY

Other rheumatoid arthritis with rheumatoid factor of shoulder

M05.811

COPY

Other rheumatoid arthritis with rheumatoid factor of right shoulder

M05.812

COPY

Other rheumatoid arthritis with rheumatoid factor of left shoulder

M05.819

COPY

Other rheumatoid arthritis with rheumatoid factor of unspecified shoulder

M05.82

COPY

Other rheumatoid arthritis with rheumatoid factor of elbow

M05.821

COPY

Other rheumatoid arthritis with rheumatoid factor of right elbow

M05.822

COPY

Other rheumatoid arthritis with rheumatoid factor of left elbow

M05.829

COPY

Other rheumatoid arthritis with rheumatoid factor of unspecified elbow

M05.83

COPY

Other rheumatoid arthritis with rheumatoid factor of wrist

M05.831

COPY

Other rheumatoid arthritis with rheumatoid factor of right wrist

M05.832

COPY

Other rheumatoid arthritis with rheumatoid factor of left wrist

M05.839

COPY

Other rheumatoid arthritis with rheumatoid factor of unspecified wrist

M05.84

COPY

Other rheumatoid arthritis with rheumatoid factor of hand

M05.841

COPY

Other rheumatoid arthritis with rheumatoid factor of right hand

M05.842

COPY

Other rheumatoid arthritis with rheumatoid factor of left hand

M05.849

COPY

Other rheumatoid arthritis with rheumatoid factor of unspecified hand

M05.85

COPY

Other rheumatoid arthritis with rheumatoid factor of hip

M05.851

COPY

Other rheumatoid arthritis with rheumatoid factor of right hip

M05.852

COPY

Other rheumatoid arthritis with rheumatoid factor of left hip

M05.859

COPY

Other rheumatoid arthritis with rheumatoid factor of unspecified hip

M05.86

COPY

Other rheumatoid arthritis with rheumatoid factor of knee

M05.861

COPY

Other rheumatoid arthritis with rheumatoid factor of right knee

M05.862

COPY

Other rheumatoid arthritis with rheumatoid factor of left knee

M05.869

COPY

Other rheumatoid arthritis with rheumatoid factor of unspecified knee

M05.87

COPY

Other rheumatoid arthritis with rheumatoid factor of ankle and foot

M05.871

COPY

Other rheumatoid arthritis with rheumatoid factor of right ankle and foot

M05.872

COPY

Other rheumatoid arthritis with rheumatoid factor of left ankle and foot

M05.879

COPY

Other rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot

M05.89

COPY

Other rheumatoid arthritis with rheumatoid factor of multiple sites

M05.8A

COPY

Other rheumatoid arthritis with rheumatoid factor of other specified site

M05.9

COPY

Rheumatoid arthritis with rheumatoid factor, unspecified

M06.0

COPY

Rheumatoid arthritis without rheumatoid factor

M06.00

COPY

Rheumatoid arthritis without rheumatoid factor, unspecified site

M06.01

COPY

Rheumatoid arthritis without rheumatoid factor, shoulder

M06.011

COPY

Rheumatoid arthritis without rheumatoid factor, right shoulder

M06.012

COPY

Rheumatoid arthritis without rheumatoid factor, left shoulder

M06.019

COPY

Rheumatoid arthritis without rheumatoid factor, unspecified shoulder

M06.02

COPY

Rheumatoid arthritis without rheumatoid factor, elbow

M06.021

COPY

Rheumatoid arthritis without rheumatoid factor, right elbow

M06.022

COPY

Rheumatoid arthritis without rheumatoid factor, left elbow

M06.029

COPY

Rheumatoid arthritis without rheumatoid factor, unspecified elbow

M06.03

COPY

Rheumatoid arthritis without rheumatoid factor, wrist

M06.031

COPY

Rheumatoid arthritis without rheumatoid factor, right wrist

M06.032

COPY

Rheumatoid arthritis without rheumatoid factor, left wrist

M06.039

COPY

Rheumatoid arthritis without rheumatoid factor, unspecified wrist

M06.04

COPY

Rheumatoid arthritis without rheumatoid factor, hand

M06.041

COPY

Rheumatoid arthritis without rheumatoid factor, right hand

M06.042

COPY

Rheumatoid arthritis without rheumatoid factor, left hand

M06.049

COPY

Rheumatoid arthritis without rheumatoid factor, unspecified hand

M06.05

COPY

Rheumatoid arthritis without rheumatoid factor, hip

M06.051

COPY

Rheumatoid arthritis without rheumatoid factor, right hip

M06.052

COPY

Rheumatoid arthritis without rheumatoid factor, left hip

M06.059

COPY

Rheumatoid arthritis without rheumatoid factor, unspecified hip

M06.06

COPY

Rheumatoid arthritis without rheumatoid factor, knee

M06.061

COPY

Rheumatoid arthritis without rheumatoid factor, right knee

M06.062

COPY

Rheumatoid arthritis without rheumatoid factor, left knee

M06.069

COPY

Rheumatoid arthritis without rheumatoid factor, unspecified knee

M06.07

COPY

Rheumatoid arthritis without rheumatoid factor, ankle and foot

M06.071

COPY

Rheumatoid arthritis without rheumatoid factor, right ankle and foot

M06.072

COPY

Rheumatoid arthritis without rheumatoid factor, left ankle and foot

M06.079

COPY

Rheumatoid arthritis without rheumatoid factor, unspecified ankle and foot

M06.08

COPY

Rheumatoid arthritis without rheumatoid factor, vertebrae

M06.09

COPY

Rheumatoid arthritis without rheumatoid factor, multiple sites

M06.0A

COPY

Rheumatoid arthritis without rheumatoid factor, other specified site

M06.8A

COPY

Other specified rheumatoid arthritis, other specified site

Polyarticular Juvenile Idiopathic Arthritis ^  Back to Top
M08.0

COPY

Unspecified juvenile rheumatoid arthritis

M08.00

COPY

Unspecified juvenile rheumatoid arthritis of unspecified site

M08.01

COPY

Unspecified juvenile rheumatoid arthritis, shoulder

M08.011

COPY

Unspecified juvenile rheumatoid arthritis, right shoulder

M08.012

COPY

Unspecified juvenile rheumatoid arthritis, left shoulder

M08.019

COPY

Unspecified juvenile rheumatoid arthritis, unspecified shoulder

M08.02

COPY

Unspecified juvenile rheumatoid arthritis, elbow

M08.021

COPY

Unspecified juvenile rheumatoid arthritis, right elbow

M08.022

COPY

Unspecified juvenile rheumatoid arthritis, left elbow

M08.029

COPY

Unspecified juvenile rheumatoid arthritis, unspecified elbow

M08.03

COPY

Unspecified juvenile rheumatoid arthritis, wrist

M08.031

COPY

Unspecified juvenile rheumatoid arthritis, right wrist

M08.032

COPY

Unspecified juvenile rheumatoid arthritis, left wrist

M08.039

COPY

Unspecified juvenile rheumatoid arthritis, unspecified wrist

M08.04

COPY

Unspecified juvenile rheumatoid arthritis, hand

M08.041

COPY

Unspecified juvenile rheumatoid arthritis, right hand

M08.042

COPY

Unspecified juvenile rheumatoid arthritis, left hand

M08.049

COPY

Unspecified juvenile rheumatoid arthritis, unspecified hand

M08.05

COPY

Unspecified juvenile rheumatoid arthritis, hip

M08.051

COPY

Unspecified juvenile rheumatoid arthritis, right hip

M08.052

COPY

Unspecified juvenile rheumatoid arthritis, left hip

M08.059

COPY

Unspecified juvenile rheumatoid arthritis, unspecified hip

M08.06

COPY

Unspecified juvenile rheumatoid arthritis, knee

M08.061

COPY

Unspecified juvenile rheumatoid arthritis, right knee

M08.062

COPY

Unspecified juvenile rheumatoid arthritis, left knee

M08.069

COPY

Unspecified juvenile rheumatoid arthritis, unspecified knee

M08.07

COPY

Unspecified juvenile rheumatoid arthritis, ankle and foot

M08.071

COPY

Unspecified juvenile rheumatoid arthritis, right ankle and foot

M08.072

COPY

Unspecified juvenile rheumatoid arthritis, left ankle and foot

M08.079

COPY

Unspecified juvenile rheumatoid arthritis, unspecified ankle and foot

M08.08

COPY

Unspecified juvenile rheumatoid arthritis, vertebrae

M08.09

COPY

Unspecified juvenile rheumatoid arthritis, multiple sites

M08.0A

COPY

Unspecified juvenile rheumatoid arthritis, other specified site

M08.2

COPY

Juvenile rheumatoid arthritis with systemic onset

M08.20

COPY

Juvenile rheumatoid arthritis with systemic onset, unspecified site

M08.21

COPY

Juvenile rheumatoid arthritis with systemic onset, shoulder

M08.211

COPY

Juvenile rheumatoid arthritis with systemic onset, right shoulder

M08.212

COPY

Juvenile rheumatoid arthritis with systemic onset, left shoulder

M08.219

COPY

Juvenile rheumatoid arthritis with systemic onset, unspecified shoulder

M08.22

COPY

Juvenile rheumatoid arthritis with systemic onset, elbow

M08.221

COPY

Juvenile rheumatoid arthritis with systemic onset, right elbow

M08.222

COPY

Juvenile rheumatoid arthritis with systemic onset, left elbow

M08.229

COPY

Juvenile rheumatoid arthritis with systemic onset, unspecified elbow

M08.23

COPY

Juvenile rheumatoid arthritis with systemic onset, wrist

M08.231

COPY

Juvenile rheumatoid arthritis with systemic onset, right wrist

M08.232

COPY

Juvenile rheumatoid arthritis with systemic onset, left wrist

M08.239

COPY

Juvenile rheumatoid arthritis with systemic onset, unspecified wrist

M08.24

COPY

Juvenile rheumatoid arthritis with systemic onset, hand

M08.241

COPY

Juvenile rheumatoid arthritis with systemic onset, right hand

M08.242

COPY

Juvenile rheumatoid arthritis with systemic onset, left hand

M08.249

COPY

Juvenile rheumatoid arthritis with systemic onset, unspecified hand

M08.25

COPY

Juvenile rheumatoid arthritis with systemic onset, hip

M08.251

COPY

Juvenile rheumatoid arthritis with systemic onset, right hip

M08.252

COPY

Juvenile rheumatoid arthritis with systemic onset, left hip

M08.259

COPY

Juvenile rheumatoid arthritis with systemic onset, unspecified hip

M08.26

COPY

Juvenile rheumatoid arthritis with systemic onset, knee

M08.261

COPY

Juvenile rheumatoid arthritis with systemic onset, right knee

M08.262

COPY

Juvenile rheumatoid arthritis with systemic onset, left knee

M08.269

COPY

Juvenile rheumatoid arthritis with systemic onset, unspecified knee

M08.27

COPY

Juvenile rheumatoid arthritis with systemic onset, ankle and foot

M08.271

COPY

Juvenile rheumatoid arthritis with systemic onset, right ankle and foot

M08.272

COPY

Juvenile rheumatoid arthritis with systemic onset, left ankle and foot

M08.279

COPY

Juvenile rheumatoid arthritis with systemic onset, unspecified ankle and foot

M08.28

COPY

Juvenile rheumatoid arthritis with systemic onset, vertebrae

M08.29

COPY

Juvenile rheumatoid arthritis with systemic onset, multiple sites

M08.2A

COPY

Juvenile rheumatoid arthritis with systemic onset, other specified site

M08.3

COPY

Juvenile rheumatoid polyarthritis (seronegative)

M08.4

COPY

Pauciarticular juvenile rheumatoid arthritis

M08.40

COPY

Pauciarticular juvenile rheumatoid arthritis, unspecified site

M08.41

COPY

Pauciarticular juvenile rheumatoid arthritis, shoulder

M08.411

COPY

Pauciarticular juvenile rheumatoid arthritis, right shoulder

M08.412

COPY

Pauciarticular juvenile rheumatoid arthritis, left shoulder

M08.419

COPY

Pauciarticular juvenile rheumatoid arthritis, unspecified shoulder

M08.42

COPY

Pauciarticular juvenile rheumatoid arthritis, elbow

M08.421

COPY

Pauciarticular juvenile rheumatoid arthritis, right elbow

M08.422

COPY

Pauciarticular juvenile rheumatoid arthritis, left elbow

M08.429

COPY

Pauciarticular juvenile rheumatoid arthritis, unspecified elbow

M08.43

COPY

Pauciarticular juvenile rheumatoid arthritis, wrist

M08.431

COPY

Pauciarticular juvenile rheumatoid arthritis, right wrist

M08.432

COPY

Pauciarticular juvenile rheumatoid arthritis, left wrist

M08.439

COPY

Pauciarticular juvenile rheumatoid arthritis, unspecified wrist

M08.44

COPY

Pauciarticular juvenile rheumatoid arthritis, hand

M08.441

COPY

Pauciarticular juvenile rheumatoid arthritis, right hand

M08.442

COPY

Pauciarticular juvenile rheumatoid arthritis, left hand

M08.449

COPY

Pauciarticular juvenile rheumatoid arthritis, unspecified hand

M08.45

COPY

Pauciarticular juvenile rheumatoid arthritis, hip

M08.451

COPY

Pauciarticular juvenile rheumatoid arthritis, right hip

M08.452

COPY

Pauciarticular juvenile rheumatoid arthritis, left hip

M08.459

COPY

Pauciarticular juvenile rheumatoid arthritis, unspecified hip

M08.46

COPY

Pauciarticular juvenile rheumatoid arthritis, knee

M08.461

COPY

Pauciarticular juvenile rheumatoid arthritis, right knee

M08.462

COPY

Pauciarticular juvenile rheumatoid arthritis, left knee

M08.469

COPY

Pauciarticular juvenile rheumatoid arthritis, unspecified knee

M08.47

COPY

Pauciarticular juvenile rheumatoid arthritis, ankle and foot

M08.471

COPY

Pauciarticular juvenile rheumatoid arthritis, right ankle and foot

M08.472

COPY

Pauciarticular juvenile rheumatoid arthritis, left ankle and foot

M08.479

COPY

Pauciarticular juvenile rheumatoid arthritis, unspecified ankle and foot

M08.48

COPY

Pauciarticular juvenile rheumatoid arthritis, vertebrae

M08.4A

COPY

Pauciarticular juvenile rheumatoid arthritis, other specified site

Adult Psoriatic Arthritis ^  Back to Top
L40

COPY

Psoriasis

L40.5

COPY

Arthropathic psoriasis

L40.50

COPY

Arthropathic psoriasis, unspecified

L40.51

COPY

Distal interphalangeal psoriatic arthropathy

L40.52

COPY

Psoriatic arthritis mutilans

L40.53

COPY

Psoriatic spondylitis

L40.59

COPY

Other psoriatic arthropathy

FDA Approval Letters as Posted by the FDA:

For moderately to severely active RA in adults (IV)
View Letter

For moderately to severely active RA in adults (SC Prefilled Syringe)
View Letter

For moderately to severely active polyarticular JIA in patients 6 years of age and older (IV)
View Letter

For moderately to severely active polyarticular JIA in patients 2 years of age and older (SC Prefilled Syringe)
View Letter

For active Psoriatic Arthritis in adults
View Letter

Please see U.S. Full Prescribing Information for ORENCIA.

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.

Please see U.S. Full Prescribing Information for ORENCIA.

*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 guidance 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:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 20, 2020.
  3. American Medical Association. Current Procedural Terminology 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  4. ORENCIA (abatacept) [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  5. American Medical Association. 2020 ICD-10-CM: The Complete Official Codebook. Chicago, IL: American Medical Association; 2019.

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.

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Use of the information on this site is subject to the terms of our Legal Notice and Privacy Statement. The coding, coverage, and payment information contained within this website is current as of 10/20.

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