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This information is intended for U.S. healthcare professionals and/or healthcare professionals involved in healthcare reimbursement.

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REVLIMID® (lenalidomide)

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Billing and
Diagnosis Codes

Myelodysplastic Syndromes

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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 REVLIMID
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  • Codes*
  • Distribution
  • FDA Letters


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Type a keyword to find a specific NDC or ICD-10 code
National Drug Codes (NDC)1Issued by the FDA
59572-0402-28

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2.5 mg bottles of 28 capsules

59572-0402-00

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2.5 mg bottles of 100 capsules

59572-0405-28

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5 mg bottles of 28 capsules

59572-0405-00

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5 mg bottles of 100 capsules

59572-0410-28

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10 mg bottles of 28 capsules

59572-0410-00

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10 mg bottles of 100 capsules

59572-0415-21

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15 mg bottles of 21 capsules

59572-0415-00

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15 mg bottles of 100 capsules

59572-0420-21

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20 mg bottles of 21 capsules

59572-0420-00

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20 mg bottles of 100 capsules

59572-0425-21

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25 mg bottles of 21 capsules

59572-0425-00

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25 mg bottles of 100 capsules

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

D46

Myelodysplastic syndromes

D46.0

Refractory anemia without ring sideroblasts, so stated

D46.1

Refractory anemia with ring sideroblasts

D46.2

Refractory anemia with excess of blasts [RAEB]

D46.20

Refractory anemia with excess of blasts, unspecified

D46.21

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Refractory anemia with excess of blasts 1

D46.22

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Refractory anemia with excess of blasts 2

D46.A

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Refractory cytopenia with multilineage dysplasia

D46.B

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Refractory cytopenia with multilineage dysplasia and ring sideroblasts

D46.C

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Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality

D46.4

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Refractory anemia, unspecified

D46.9

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Myelodysplastic syndrome, unspecified

Prescribers and pharmacies must be certified with the Lenalidomide REMS program by enrolling and complying with the REMS requirements; pharmacies must only dispense to patients who are authorized to receive REVLIMID. 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 1-787-781-4885 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 04/22.

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

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

FDA Approval Letter as Posted by the FDA:

For the treatment of adult patients with transfusion dependent anemia due to low or intermediate-1 risk myelodysplastic syndromes associated with a deletion 5q cytogenetic abnormality with or without additional cytogenetic abnormalities

View Letter

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

Coding for REVLIMID 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 REVLIMID, 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:

  1. REVLIMID [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  2. Centers for Medicare & Medicaid Services. ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-CM. Accessed January 24, 2022.

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 04/22.

2003-US-2100513 04/22