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 POMALYST
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Codes*
Distribution
FDA Letters

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Type a keyword to find a specific NDC or ICD-10 code for Multiple Myeloma or Kaposi's Sarcoma

National Drug Codes (NDC)¹Issued by the FDA

59572-501-21

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1 mg/1 capsule bottles of 21

59572-501-00

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1 mg/1 capsule bottles of 100

59572-502-21

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2 mg/1 capsule bottles of 21

59572-502-00

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2 mg/1 capsule bottles of 100

59572-503-21

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3 mg/1 capsule bottles of 21

59572-503-00

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3 mg/1 capsule bottles of 100

59572-504-21

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4 mg/1 capsule bottles of 21

59572-504-00

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4 mg/1 capsule bottles of 100

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)²

Multiple Myeloma ICD-10 Codes

C90

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Multiple myeloma and malignant plasma cell neoplasms

C90.0

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Multiple myeloma

C90.00

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Multiple myeloma not having achieved remission

C90.01

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Multiple myeloma in remission

C90.02

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Multiple myeloma in relapse

Kaposi's Sarcoma (KS) ICD-10 Codes

C46

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Kaposi’s sarcoma

C46.0

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Kaposi’s sarcoma of skin

C46.1

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Kaposi's sarcoma of soft tissue

C46.2

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Kaposi's sarcoma of palate

C46.3

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Kaposi's sarcoma of lymph nodes

C46.4

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Kaposi's sarcoma of gastrointestinal sites

C46.5

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Kaposi's sarcoma of lung

C46.50

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Kaposi's sarcoma of unspecified lung

C46.51

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Kaposi’s sarcoma of right lung

C46.52

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Kaposi’s sarcoma of left lung

C46.7

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Kaposi’s sarcoma of other sites

C46.9

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Kaposi’s sarcoma, unspecified

Prescribers and pharmacies must be certified with the POMALYST REMS^® program by enrolling and complying with the REMS requirements; pharmacies must only dispense to patients who are authorized to receive POMALYST. The REMS-Pharmacy Network list includes specialty pharmacies that are contracted to fill prescriptions for restricted distribution programs for Bristol Myers Squibb.

Specialty Pharmacies

Pharmacy	Phone	Fax
Absolute Pharmacy	1-787-892-8700	1-787-496-1010
AcariaHealth Pharmacy	1-866-458-9246	1-866-458-9245
Accredo Specialty Pharmacy	1-877-732-3431	1-800-590-1021
ACS Advanced Care Scripts	1-877-985-6337	1-866-679-7131
AllianceRx Walgreens Prime	1-888-347-3416	1-877-231-8302
Amber Specialty Pharmacy	1-888-370-1724	1-877-645-7514
Axium Healthcare Puerto Rico	1-787-780-7200	1-800-546-2163
Biologics by McKesson	1-800-850-4306	1-800-823-4506
Biomatrix	1-888-662-6779	1-877-800-4790
BioPlus Specialty Pharmacy	1-888-292-0744	1-800-269-5493
CareMed Specialty Pharmacy	1-877-227-3405	1-877-542-2731
CVS Specialty	1-800-237-2767	1-800-323-2445
Farmacia San Rafael	1-787-724-3333	1-787-721-4165
Humana Specialty Pharmacy	1-800-486-2668	1-877-405-7940
Kroger Specialty Pharmacy	1-888-327-2962	1-888-315-3270
Magellan Rx Pharmacy (ICORE)	1-866-554-2673	1-866-364-2673
Onco360	1-877-662-6633	1-877-662-6355
Optum Specialty Pharmacy	1-877-445-6874	1-866-306-5231
RxCrossroads by McKesson (VA Dispensing)	1-855-637-9433	1-855-637-9446
Special Care Pharmacy Services	1-787-781-4585	1-787-783-2951
Upstate Pharmacy	1-800-314-4655	1-800-314-7756
US Bioservices	1-877-757-0667	1-888-899-0067

Above information is accurate as of 12/21.

The POMALYST distribution program includes extended payment terms to Bristol Myers Squibb authorized POMALYST distributors. Healthcare providers and institutions should contact their POMALYST distributor to understand specific payment terms that may be available to them from their distributor.

Please see U.S. Full Prescribing Information for POMALYST, including Boxed WARNINGS.

FDA Approval Letters as Posted by the FDA:

In combination with dexamethasone, for treatment of patients with multiple myeloma who have received at least two prior therapies including lenalidomide and a proteasome inhibitor and have demonstrated disease progression on or within 60 days of completion of the last therapy
View Letter

For the treatment of adult patients with AIDS-related Kaposi sarcoma (KS) after failure of highly active antiretroviral therapy (HAART) or in patients with KS who are HIV-negative^†
View Letter

^†This indication is approved under accelerated approval based on overall response rate. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial(s).

Please see U.S. Full Prescribing Information for POMALYST, including Boxed WARNINGS.

Coding for POMALYST is dependent on the insurer and the care setting in which the drug will be administered. Oncology practices need to make coding decisions based on the diagnosis and treatment of each patient and the specific insurer requirements.

Please see U.S. Full Prescribing Information for POMALYST, including Boxed WARNINGS.

*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.

References:

POMALYST [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.