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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
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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
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Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
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Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
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Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
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.
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250 mg in a 15-mL single-use vial, in a clamshell presentation
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250 mg in a 15-mL single-use vial, in a carton presentation
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Pack of 4 syringes with a passive needle safety guard (50 mg/0.4 mL pre-filled syringe)
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Pack of 4 syringes with a passive needle safety guard (87.5 mg/0.7 mL pre-filled syringe)
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Pack of 4 syringes with a passive needle safety guard (125 mg/1 mL pre-filled syringe)
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Pack of 4 single-dose autoinjectors (125 mg/1 mL)
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Rheumatoid arthritis with rheumatoid factor without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of unspecified site without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of shoulder without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of right shoulder without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of left shoulder without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of unspecified shoulder without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of elbow without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of right elbow without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of left elbow without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of unspecified elbow without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of wrist without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of right wrist without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of left wrist without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of unspecified wrist without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of hand without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of right hand without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of left hand without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of unspecified hand without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of hip without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of right hip without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of left hip without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of unspecified hip without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of knee without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of right knee without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of left knee without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of unspecified knee without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of ankle and foot without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of right ankle and foot without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of left ankle and foot without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement
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Rheumatoid arthritis with rheumatoid factor of other specified site without organ or systems involvement
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Other rheumatoid arthritis with rheumatoid factor
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Other rheumatoid arthritis with rheumatoid factor of unspecified site
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Other rheumatoid arthritis with rheumatoid factor of shoulder
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Other rheumatoid arthritis with rheumatoid factor of right shoulder
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Other rheumatoid arthritis with rheumatoid factor of left shoulder
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Other rheumatoid arthritis with rheumatoid factor of unspecified shoulder
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Other rheumatoid arthritis with rheumatoid factor of elbow
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Other rheumatoid arthritis with rheumatoid factor of right elbow
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Other rheumatoid arthritis with rheumatoid factor of left elbow
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Other rheumatoid arthritis with rheumatoid factor of unspecified elbow
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Other rheumatoid arthritis with rheumatoid factor of wrist
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Other rheumatoid arthritis with rheumatoid factor of right wrist
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Other rheumatoid arthritis with rheumatoid factor of left wrist
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Other rheumatoid arthritis with rheumatoid factor of unspecified wrist
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Other rheumatoid arthritis with rheumatoid factor of hand
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Other rheumatoid arthritis with rheumatoid factor of right hand
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Other rheumatoid arthritis with rheumatoid factor of left hand
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Other rheumatoid arthritis with rheumatoid factor of unspecified hand
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Other rheumatoid arthritis with rheumatoid factor of hip
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Other rheumatoid arthritis with rheumatoid factor of right hip
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Other rheumatoid arthritis with rheumatoid factor of left hip
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Other rheumatoid arthritis with rheumatoid factor of unspecified hip
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Other rheumatoid arthritis with rheumatoid factor of knee
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Other rheumatoid arthritis with rheumatoid factor of right knee
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Other rheumatoid arthritis with rheumatoid factor of left knee
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Other rheumatoid arthritis with rheumatoid factor of unspecified knee
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Other rheumatoid arthritis with rheumatoid factor of ankle and foot
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Other rheumatoid arthritis with rheumatoid factor of right ankle and foot
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Other rheumatoid arthritis with rheumatoid factor of left ankle and foot
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Other rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot
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Other rheumatoid arthritis with rheumatoid factor of multiple sites
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Other rheumatoid arthritis with rheumatoid factor of other specified site
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Rheumatoid arthritis with rheumatoid factor, unspecified
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Rheumatoid arthritis without rheumatoid factor
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Rheumatoid arthritis without rheumatoid factor, unspecified site
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Rheumatoid arthritis without rheumatoid factor, shoulder
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Rheumatoid arthritis without rheumatoid factor, right shoulder
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Rheumatoid arthritis without rheumatoid factor, left shoulder
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Rheumatoid arthritis without rheumatoid factor, unspecified shoulder
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Rheumatoid arthritis without rheumatoid factor, elbow
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Rheumatoid arthritis without rheumatoid factor, right elbow
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Rheumatoid arthritis without rheumatoid factor, left elbow
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Rheumatoid arthritis without rheumatoid factor, unspecified elbow
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Rheumatoid arthritis without rheumatoid factor, wrist
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Rheumatoid arthritis without rheumatoid factor, right wrist
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Rheumatoid arthritis without rheumatoid factor, left wrist
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Rheumatoid arthritis without rheumatoid factor, unspecified wrist
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Rheumatoid arthritis without rheumatoid factor, hand
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Rheumatoid arthritis without rheumatoid factor, right hand
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Rheumatoid arthritis without rheumatoid factor, left hand
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Rheumatoid arthritis without rheumatoid factor, unspecified hand
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Rheumatoid arthritis without rheumatoid factor, hip
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Rheumatoid arthritis without rheumatoid factor, right hip
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Rheumatoid arthritis without rheumatoid factor, left hip
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Rheumatoid arthritis without rheumatoid factor, unspecified hip
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Rheumatoid arthritis without rheumatoid factor, knee
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Rheumatoid arthritis without rheumatoid factor, right knee
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Rheumatoid arthritis without rheumatoid factor, left knee
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Rheumatoid arthritis without rheumatoid factor, unspecified knee
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Rheumatoid arthritis without rheumatoid factor, ankle and foot
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Rheumatoid arthritis without rheumatoid factor, right ankle and foot
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Rheumatoid arthritis without rheumatoid factor, left ankle and foot
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Rheumatoid arthritis without rheumatoid factor, unspecified ankle and foot
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Rheumatoid arthritis without rheumatoid factor, vertebrae
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Rheumatoid arthritis without rheumatoid factor, multiple sites
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Rheumatoid arthritis without rheumatoid factor, other specified site
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Other specified rheumatoid arthritis, other specified site
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Unspecified juvenile rheumatoid arthritis
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Unspecified juvenile rheumatoid arthritis of unspecified site
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Unspecified juvenile rheumatoid arthritis, shoulder
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Unspecified juvenile rheumatoid arthritis, right shoulder
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Unspecified juvenile rheumatoid arthritis, left shoulder
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Unspecified juvenile rheumatoid arthritis, unspecified shoulder
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Unspecified juvenile rheumatoid arthritis, elbow
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Unspecified juvenile rheumatoid arthritis, right elbow
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Unspecified juvenile rheumatoid arthritis, left elbow
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Unspecified juvenile rheumatoid arthritis, unspecified elbow
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Unspecified juvenile rheumatoid arthritis, wrist
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Unspecified juvenile rheumatoid arthritis, right wrist
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Unspecified juvenile rheumatoid arthritis, left wrist
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Unspecified juvenile rheumatoid arthritis, unspecified wrist
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Unspecified juvenile rheumatoid arthritis, hand
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Unspecified juvenile rheumatoid arthritis, right hand
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Unspecified juvenile rheumatoid arthritis, left hand
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Unspecified juvenile rheumatoid arthritis, unspecified hand
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Unspecified juvenile rheumatoid arthritis, hip
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Unspecified juvenile rheumatoid arthritis, right hip
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Unspecified juvenile rheumatoid arthritis, left hip
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Unspecified juvenile rheumatoid arthritis, unspecified hip
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Unspecified juvenile rheumatoid arthritis, knee
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Unspecified juvenile rheumatoid arthritis, right knee
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Unspecified juvenile rheumatoid arthritis, left knee
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Unspecified juvenile rheumatoid arthritis, unspecified knee
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Unspecified juvenile rheumatoid arthritis, ankle and foot
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Unspecified juvenile rheumatoid arthritis, right ankle and foot
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Unspecified juvenile rheumatoid arthritis, left ankle and foot
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Unspecified juvenile rheumatoid arthritis, unspecified ankle and foot
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Unspecified juvenile rheumatoid arthritis, vertebrae
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Unspecified juvenile rheumatoid arthritis, multiple sites
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Unspecified juvenile rheumatoid arthritis, other specified site
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Juvenile rheumatoid arthritis with systemic onset
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Juvenile rheumatoid arthritis with systemic onset, unspecified site
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Juvenile rheumatoid arthritis with systemic onset, shoulder
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Juvenile rheumatoid arthritis with systemic onset, right shoulder
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Juvenile rheumatoid arthritis with systemic onset, left shoulder
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Juvenile rheumatoid arthritis with systemic onset, unspecified shoulder
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Juvenile rheumatoid arthritis with systemic onset, elbow
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Juvenile rheumatoid arthritis with systemic onset, right elbow
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Juvenile rheumatoid arthritis with systemic onset, left elbow
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Juvenile rheumatoid arthritis with systemic onset, unspecified elbow
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Juvenile rheumatoid arthritis with systemic onset, wrist
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Juvenile rheumatoid arthritis with systemic onset, right wrist
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Juvenile rheumatoid arthritis with systemic onset, left wrist
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Juvenile rheumatoid arthritis with systemic onset, unspecified wrist
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Juvenile rheumatoid arthritis with systemic onset, hand
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Juvenile rheumatoid arthritis with systemic onset, right hand
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Juvenile rheumatoid arthritis with systemic onset, left hand
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Juvenile rheumatoid arthritis with systemic onset, unspecified hand
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Juvenile rheumatoid arthritis with systemic onset, hip
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Juvenile rheumatoid arthritis with systemic onset, right hip
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Juvenile rheumatoid arthritis with systemic onset, left hip
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Juvenile rheumatoid arthritis with systemic onset, unspecified hip
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Juvenile rheumatoid arthritis with systemic onset, knee
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Juvenile rheumatoid arthritis with systemic onset, right knee
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Juvenile rheumatoid arthritis with systemic onset, left knee
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Juvenile rheumatoid arthritis with systemic onset, unspecified knee
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Juvenile rheumatoid arthritis with systemic onset, ankle and foot
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Juvenile rheumatoid arthritis with systemic onset, right ankle and foot
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Juvenile rheumatoid arthritis with systemic onset, left ankle and foot
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Juvenile rheumatoid arthritis with systemic onset, unspecified ankle and foot
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Juvenile rheumatoid arthritis with systemic onset, vertebrae
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Juvenile rheumatoid arthritis with systemic onset, multiple sites
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Juvenile rheumatoid arthritis with systemic onset, other specified site
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Juvenile rheumatoid polyarthritis (seronegative)
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Pauciarticular juvenile rheumatoid arthritis
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Pauciarticular juvenile rheumatoid arthritis, unspecified site
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Pauciarticular juvenile rheumatoid arthritis, shoulder
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Pauciarticular juvenile rheumatoid arthritis, right shoulder
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Pauciarticular juvenile rheumatoid arthritis, left shoulder
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Pauciarticular juvenile rheumatoid arthritis, unspecified shoulder
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Pauciarticular juvenile rheumatoid arthritis, elbow
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Pauciarticular juvenile rheumatoid arthritis, right elbow
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Pauciarticular juvenile rheumatoid arthritis, left elbow
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Pauciarticular juvenile rheumatoid arthritis, unspecified elbow
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Pauciarticular juvenile rheumatoid arthritis, wrist
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Pauciarticular juvenile rheumatoid arthritis, right wrist
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Pauciarticular juvenile rheumatoid arthritis, left wrist
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Pauciarticular juvenile rheumatoid arthritis, unspecified wrist
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Pauciarticular juvenile rheumatoid arthritis, hand
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Pauciarticular juvenile rheumatoid arthritis, right hand
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Pauciarticular juvenile rheumatoid arthritis, left hand
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Pauciarticular juvenile rheumatoid arthritis, unspecified hand
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Pauciarticular juvenile rheumatoid arthritis, hip
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Pauciarticular juvenile rheumatoid arthritis, right hip
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Pauciarticular juvenile rheumatoid arthritis, left hip
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Pauciarticular juvenile rheumatoid arthritis, unspecified hip
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Pauciarticular juvenile rheumatoid arthritis, knee
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Pauciarticular juvenile rheumatoid arthritis, right knee
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Pauciarticular juvenile rheumatoid arthritis, left knee
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Pauciarticular juvenile rheumatoid arthritis, unspecified knee
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Pauciarticular juvenile rheumatoid arthritis, ankle and foot
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Pauciarticular juvenile rheumatoid arthritis, right ankle and foot
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Pauciarticular juvenile rheumatoid arthritis, left ankle and foot
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Pauciarticular juvenile rheumatoid arthritis, unspecified ankle and foot
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Pauciarticular juvenile rheumatoid arthritis, vertebrae
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Pauciarticular juvenile rheumatoid arthritis, other specified site
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Psoriasis
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Arthropathic psoriasis
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Arthropathic psoriasis, unspecified
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Distal interphalangeal psoriatic arthropathy
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Psoriatic arthritis mutilans
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Psoriatic spondylitis
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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:
- 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 July 20, 2020.
- American Medical Association. Current Procedural Terminology 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- ORENCIA (abatacept) [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- 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.