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 YERVOY
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- Codes*
- Distribution
- FDA Letters
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Injection, ipilimumab, 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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Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
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Chemotherapy administration, IV infusion; each additional hour - List separately in addition to code for primary procedures - Use 96415 in conjunction with 96413 - Report 96415 for infusion intervals of greater than 30 minutes beyond 1-hour increments
Note:The NDCs for YERVOY, shown here, are often necessary in addition to the appropriate J- or C-code when filing a claim for reimbursement.
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One 50-mg vial (5 mg/mL), single-dose vial
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One 200-mg vial (5 mg/mL), single-dose vial
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Malignant melanoma of skin
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Malignant melanoma of lip
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Malignant melanoma of eyelid, including canthus
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Malignant melanoma of unspecified eyelid, including canthus
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Malignant melanoma of right eyelid, including canthus
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Malignant melanoma of right upper eyelid, including canthus
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Malignant melanoma of right lower eyelid, including canthus
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Malignant melanoma of left eyelid, including canthus
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Malignant melanoma of left upper eyelid, including canthus
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Malignant melanoma of left lower eyelid, including canthus
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Malignant melanoma of ear and external auricular canal
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Malignant melanoma of unspecified ear and external auricular canal
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Malignant melanoma of right ear and external auricular canal
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Malignant melanoma of left ear and external auricular canal
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Malignant melanoma of other and unspecified parts of face
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Malignant melanoma of unspecified part of face
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Malignant melanoma of nose
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Malignant melanoma of other parts of face
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Malignant melanoma of scalp and neck
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Malignant melanoma of trunk
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Malignant melanoma of anal skin
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Malignant melanoma of skin of breast
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Malignant melanoma of other part of trunk
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Malignant melanoma of upper limb, including shoulder
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Malignant melanoma of unspecified upper limb, including shoulder
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Malignant melanoma of right upper limb, including shoulder
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Malignant melanoma of left upper limb, including shoulder
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Malignant melanoma of lower limb, including hip
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Malignant melanoma of unspecified lower limb, including hip
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Malignant melanoma of right lower limb, including hip
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Malignant melanoma of left lower limb, including hip
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Malignant melanoma of overlapping sites of skin
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Malignant melanoma of skin, unspecified
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Malignant neoplasm of anus and anal canal
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Malignant neoplasm of anus, unspecified
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Malignant neoplasm of anal canal
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Malignant neoplasm of vulva
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Malignant neoplasm of labium majus
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Malignant neoplasm of labium minus
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Malignant neoplasm of clitoris
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Malignant neoplasm of vulva, unspecified
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Malignant neoplasm of vagina
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Malignant neoplasm of other and unspecified female genital organs
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Malignant neoplasm of other specified female genital organs
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Malignant neoplasm of overlapping sites of female genital organs
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Malignant neoplasm of female genital organ, unspecified
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Malignant neoplasm of penis
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Malignant neoplasm of prepuce
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Malignant neoplasm of glans penis
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Malignant neoplasm of overlapping sites of penis
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Malignant neoplasm of penis, unspecified
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Malignant neoplasm of other and unspecified male genital organs
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Malignant neoplasm of epididymis
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Malignant neoplasm of unspecified epididymis
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Malignant neoplasm of right epididymis
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Malignant neoplasm of left epididymis
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Malignant neoplasm of spermatic cord
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Malignant neoplasm of unspecified spermatic cord
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Malignant neoplasm of right spermatic cord
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Malignant neoplasm of left spermatic cord
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Malignant neoplasm of scrotum
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Malignant neoplasm of other specified male genital organs
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Malignant neoplasm of overlapping sites of male genital organs
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Malignant neoplasm of male genital organ, unspecified
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Encounter for antineoplastic immunotherapy (only)
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.
YERVOY may be purchased through the distributors listed below.
Physician Offices
Specialty Distributor | Phone Orders | Fax Orders and Website |
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Cardinal Health Specialty Pharmaceutical Distribution | 1-877-453-3972 | https://specialtyonline.cardinalhealth.com |
CuraScript Specialty Distribution | 1-877-599-7748 | https://www.curascriptsd.com |
McKesson Specialty Health | 1-800-482-6700 | https://mscs.mckesson.com |
Morris & Dickson Specialty | 1-800-710-6100 | Fax: 1-318-524-3096 https://www.mdspecialtydist.com |
Oncology Supply | 1-800-633-7555 | https://www.oncologysupply.com |
For offices that prefer to use the services of a specialty pharmacy, specialty pharmacies can obtain YERVOY 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 | Fax: 1-800-547-9413 https://www.asdhealthcare.com |
Cardinal Health Specialty Pharmaceutical Distribution | 1-866-677-4844 | Fax: 1-614-553-6301 https://orderexpress.cardinalhealth.com |
DMS Pharmaceutical Group, Inc. | 1-877-788-1100 | Fax: 1-847-518-1105 https://www.dmspharma.com |
McKesson Plasma and Biologics | 1-877-625-2566 | Fax: 1-888-752-7626 https://connect.mckesson.com |
Puerto Rico Hospitals and Clinics
Authorized Distributor | Phone Orders | Fax Orders and Website |
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Cardinal Puerto Rico (Borschow) | 1-787-625-4200 | https://orderexpress.cardinalhealth.com |
Cesar Castillo Inc. | 1-787-641-5242 (Hospitals) 1-787-641-5082 (Specialty Pharmacies) |
Fax: 1-787-999-1614 https://www.facilfarmaciacci.com |
Above information is accurate as of 06/22.
The YERVOY distribution program includes extended payment terms to Bristol Myers Squibb authorized YERVOY distributors. Healthcare providers and institutions should contact their YERVOY distributor to understand specific payment terms that may be available to them from their distributor.
Please see U.S. Full Prescribing Information for YERVOY.
FDA Approval Letters as Posted by the FDA:
For the adjuvant treatment of fully resected stage III melanoma (lymph node >1 mm)
View Letter
For the treatment of unresectable or metastatic melanoma to include pediatric patients (12 years and older)
View Letter
For the treatment of unresectable or metastatic melanoma in adults
View Letter
Please see U.S. Full Prescribing Information for YERVOY.
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.