Codes and coverage

Codes and coverage

Supporting patient access

BMS Access Support® may help support patient access by conducting benefits reviews and offering prior authorization and appeals process assistance for enrolled patients. Additionally, the information below provides product-specific billing and diagnosis codes, reimbursement and coding guides, distribution information, and additional coverage support offerings. To view available coding and coverage information, please select your patient’s prescribed medication.

Additional eligibility criteria and terms may apply. Bristol Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.

Read more about our coverage support offerings
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Benefits Reviews

  • Once a patient is enrolled in BMS Access Support, we can review their insurance coverage and provide a summary of benefits within approximately 24 hours*
  • A benefits review may help determine whether or not a medication is covered, if a PA is required, and estimated patient out-of-pocket costs

*BMS Access Support Data - Benefits review. Accessed August 2022.

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Prior Authorization (PA) and Appeals Assistance

  • Use the BMS Access Map to identify plan-specific PA requirements
  • View our forms and resources page for helpful support tools, including appeals letter templates and medical necessity letters

Annual Reverification

  • Reverification of benefits is available upon request to confirm a patient’s benefits for the new year
  • Connect with your local Access and Reimbursement Manager for more information
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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.

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Reimbursement and Coding Guide
for AUGTYRO

Additional coverage support offerings

Free Trial Offer

A free trial offer may be available for patients newly prescribed AUGTYRO.

Bridge Program

Has your commercially insured patient experienced a delay in coverage or a coverage denial for AUGTYRO? They may be eligible for a bridge program while they await coverage.

To learn more about the eligibility requirements for the Free Trial offer or Bridge Program, call BMS Access Support at 1-800-861-0048 or reach out to your local Access and Reimbursement Manager for more information.

Restrictions apply. Please see full Terms and Conditions, including complete eligibility requirements.

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National Drug Codes (NDC)1

Issued 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.

00003-4040-60 Copy 40 mg capsules, bottles of 60 capsules
00003-4040-12 Copy 40 mg capsules, bottles of 120 capsules

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

C33 Malignant neoplasm of trachea
C34.0 Malignant neoplasm of main bronchus
C34.00 Malignant neoplasm of unspecified main bronchus
C34.01 Malignant neoplasm of right main bronchus
C34.02 Malignant neoplasm of left main bronchus
C34.1 Malignant neoplasm of upper lobe, bronchus or lung
C34.10 Malignant neoplasm of upper lobe, unspecified bronchus or lung
C34.11 Malignant neoplasm of upper lobe, right bronchus or lung
C34.12 Malignant neoplasm of upper lobe, left bronchus or lung
C34.2 Malignant neoplasm of middle lobe, bronchus or lung
C34.3 Malignant neoplasm of lower lobe, bronchus or lung
C34.30 Malignant neoplasm of lower lobe, unspecified bronchus or lung
C34.31 Malignant neoplasm of lower lobe, right bronchus or lung
C34.32 Malignant neoplasm of lower lobe, left bronchus or lung
C34.8 Malignant neoplasm of overlapping sites of bronchus and lung
C34.80 Malignant neoplasm of overlapping sites of unspecified bronchus and lung
C34.81 Malignant neoplasm of overlapping sites of right bronchus and lung
C34.82 Malignant neoplasm of overlapping sites of left bronchus and lung
C34.9 Malignant neoplasm of unspecified part of bronchus or lung
C34.90 Malignant neoplasm of unspecified part of bronchus or lung
Lung cancer NOS
C34.91 Malignant neoplasm of unspecified part of right bronchus or lung
C34.92 Malignant neoplasm of unspecified part of left bronchus or lung

Coding for AUGTYRO 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 AUGTYRO .

NOS=not otherwise specified.

*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 information 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. AUGTYRO [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-billing/icd-10-codes/2023-icd-10-cm. September 15, 2023.

The following distributors are authorized to sell AUGTYRO and are able to service qualified accounts.

Physician Offices

Specialty Distributor Phone Orders Fax Orders and Website
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

Hospitals and Infusion Centers

Specialty Distributor Phone Orders Fax Orders and Website
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
McKesson Plasma and Biologics 1‑877‑625‑2566 Fax: 1‑888‑752‑7626
https://connect.mckesson.com
Morris & Dickson Specialty 1‑800‑710‑6100 Fax: 1‑318‑524‑3096
https://www.mdspecialtydist.com

Puerto Rico Hospitals and Clinics

Authorized Distributor Phone Orders Fax Orders and Website
Amerisource
Bergen Puerto Rico
1‑844‑222‑2273 https://abcorder.amerisourcebergen.com
Cardinal Puerto Rico (Borschow) 1‑787‑625‑4200 https://www.cardinalhealth.pr/
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 12/23.

AUGTYRO is available through external specialty pharmacies. Please check with your patient's insurance plan for the appropriate specialty pharmacy.

AUGTYRO can also be procured by the practice directly from one of the authorized distributors in the list above. Please ensure your practice has the durable medical equipment (DME) license in place to bill the appropriate DME Medicare Administrative Contractor (DME MAC).

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

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

FDA Approval Letter as Posted by the FDA:

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AUGTYRO for the treatment of adult patients with locally advanced or metastatic ROS1-positive non-small cell lung cancer (NSCLC) – Approved on 11/15/2023

View Letter

Please see U.S. Full Prescribing Information for AUGTYRO for complete indications.