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

Current Procedural Terminology (CPT)2†

The CPT codes below may be appropriate to use when billing for ROS1 and NTRK testing.

NGS Tests

81445 Copy Solid organ neoplasm, genomic sequence analysis panel, 5-50 genes, interrogation for sequence variants and copy number variants or rearrangements, if performed; DNA analysis or combined DNA and RNA analysis
81450 Copy Hematolymphoid neoplasm or disorder, genomic sequence analysis panel, 5-50 genes, interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; DNA analysis or combined DNA and RNA analysis
81455 Copy Solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes, genomic sequence analysis panel, interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; DNA analysis or combined DNA and RNA analysis

IHC Tests

88341 Copy Immunohistochemistry or immunocytochemistry, each additional single antibody stain procedure (List separately in addition to code for primary procedure)
88342 Copy Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure

FISH Tests

88364 Copy In situ hybridization (eg, FISH), per specimen; each additional single probe stain procedure (List separately in addition to code for primary procedure)
88365 Copy In situ hybridization (eg, FISH), per specimen; initial single probe stain procedure
88374 Copy Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each multiplex probe stain procedure
88377 Copy Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each multiplex probe stain procedure

RT-PCR Test

81479 Copy Unlisted molecular pathology procedure

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)3

Breast Cancer ICD-10 Codes

C50 Copy Malignant neoplasm of breast
C50.0 Copy Malignant neoplasm of nipple and areola
C50.01–C50.019 Copy Malignant neoplasm of nipple and areola, female
C50.02–C50.029 Copy Malignant neoplasm of nipple and areola, male
C50.1 Copy Malignant neoplasm of central portion of breast
C50.11–C50.119 Copy Malignant neoplasm of central portion of breast, female
C50.12–C50.129 Copy Malignant neoplasm of central portion of breast, male
C50.2 Copy Malignant neoplasm of upper-inner quadrant of breast
C50.21–C50.219 Copy Malignant neoplasm of upper-inner quadrant of breast, female
C50.22–C50.229 Copy Malignant neoplasm of upper-inner quadrant of breast, male
C50.3 Copy Malignant neoplasm of lower-inner quadrant of breast
C50.31–C50.319 Copy Malignant neoplasm of lower-inner quadrant of breast, female
C50.32–C50.329 Copy Malignant neoplasm of lower-inner quadrant of breast, male
C50.4 Copy Malignant neoplasm of upper-outer quadrant of breast
C50.41–C50.419 Copy Malignant neoplasm of upper-outer quadrant of breast, female
C50.42–C50.429 Copy Malignant neoplasm of upper-outer quadrant of breast, male
C50.5 Copy Malignant neoplasm of lower-outer quadrant of breast
C50.51–C50.519 Copy Malignant neoplasm of lower-outer quadrant of breast, female
C50.52–C50.529 Copy Malignant neoplasm of lower-outer quadrant of breast, male
C50.6 Copy Malignant neoplasm of axillary tail of breast
C50.61–C50.619 Copy Malignant neoplasm of axillary tail of breast, female
C50.62–C50.629 Copy Malignant neoplasm of axillary tail of breast, male
C50.8 Copy Malignant neoplasm of overlapping sites of breast
C50.81–C50.819 Copy Malignant neoplasm of overlapping sites of breast, female
C50.82–C50.829 Copy Malignant neoplasm of overlapping sites of breast, male
C50.9 Copy Malignant neoplasm of breast of unspecified site
C50.91–C50.919 Copy Malignant neoplasm of breast of unspecified site, female
C50.92–C50.929 Copy Malignant neoplasm of breast of unspecified site, male

Intrahepatic Bile Duct Carcinoma ICD-10 Codes

C22.1 Intrahepatic bile duct carcinoma Copy

Colorectal Cancer ICD-10 Codes

C18 Copy Malignant neoplasm of colon
C18.0 Copy Malignant neoplasm of cecum
C18.1 Copy Malignant neoplasm of appendix
C18.2 Copy Malignant neoplasm of ascending colon
C18.3 Copy Malignant neoplasm of hepatic flexure
C18.4 Copy Malignant neoplasm of transverse colon
C18.5 Copy Malignant neoplasm of splenic flexure
C18.6 Copy Malignant neoplasm of descending colon
C18.7 Copy Malignant neoplasm of sigmoid colon
C18.8 Copy Malignant neoplasm of overlapping sites of colon
C18.9 Copy Malignant neoplasm of colon, unspecified
C19 Copy Malignant neoplasm of rectosigmoid junction
C20 Copy Malignant neoplasm of rectum
C21.8 Copy Malignant neoplasm of overlapping sites of rectum, anus and anal canal
C48 Copy Malignant neoplasm of retroperitoneum and peritoneum
C48.0 Copy Malignant neoplasm of retroperitoneum
C48.1 Copy Malignant neoplasm of specified parts of peritoneum
C48.2 Copy Malignant neoplasm of peritoneum, unspecified
C48.8 Copy Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum

Gynecological Cancer ICD-10 Codes

C52 Copy Malignant neoplasm of vagina
C53-C53.9 Copy Malignant neoplasm of cervix uteri
C54-C54.9 Copy Malignant neoplasm of corpus uteri
C55 Copy Malignant neoplasm of uterus, part unspecified
C56-C56.9 Copy Malignant neoplasm of ovary
C57 Copy Malignant neoplasm of other and unspecified female genital organs
C57.0 Copy Malignant neoplasm of fallopian tube
C57.00 Copy Malignant neoplasm of unspecified fallopian tube
C57.01 Copy Malignant neoplasm of right fallopian tube
C57.02 Copy Malignant neoplasm of left fallopian tube
C57.7 Copy Malignant neoplasm of other specified female genital organs
C57.8 Copy Malignant neoplasm of overlapping sites of female genital organs
C57.9 Copy Malignant neoplasm of female genital organ, unspecified

Neuroendocrine Cancer ICD-10 Codes

C7A Copy Malignant neuroendocrine tumors
C7A.0 Copy Malignant carcinoid tumors
C7A.00 Copy Malignant carcinoid tumor of unspecified site
C7A.01 Copy Malignant carcinoid tumors of the small intestine
C7A.010 Copy Malignant carcinoid tumor of the duodenum
C7A.011 Copy Malignant carcinoid tumor of the jejunum
C7A.012 Copy Malignant carcinoid tumor of the ileum
C7A.019 Copy Malignant carcinoid tumor of the small intestine, unspecified portion
C7A.02 Copy Malignant carcinoid tumors of the appendix, large intestine, and rectum
C7A.020 Copy Malignant carcinoid tumor of the appendix
C7A.021 Copy Malignant carcinoid tumor of the cecum
C7A.022 Copy Malignant carcinoid tumor of the ascending colon
C7A.023 Copy Malignant carcinoid tumor of the transverse colon
C7A.024 Copy Malignant carcinoid tumor of the descending colon
C7A.025 Copy Malignant carcinoid tumor of the sigmoid colon
C7A.026 Copy Malignant carcinoid tumor of the rectum
C7A.029 Copy Malignant carcinoid tumor of the large intestine, unspecified portion
C7A.09 Copy Malignant carcinoid tumor of other sites
C7A.090 Copy Malignant carcinoid tumor of the bronchus and lung
C7A.091 Copy Malignant carcinoid tumor of the thymus
C7A.092 Copy Malignant carcinoid tumor of the stomach
C7A.093 Copy Malignant carcinoid tumor of the kidney
C7A.094 Copy Malignant carcinoid tumor of the foregut, unspecified
C7A.095 Copy Malignant carcinoid tumor of the midgut, unspecified
C7A.096 Copy Malignant carcinoid tumor of the hindgut, unspecified
C7A.098 Copy Malignant carcinoid tumor of other sites
C7A.1 Copy Malignant poorly differentiated neuroendocrine tumors
C7A.8 Copy Other malignant neuroendocrine tumors

Non-small Cell Lung Cancer ICD-10 Codes

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 unspecified bronchus or lung
C34.91 Malignant neoplasm of unspecified part of right bronchus or lung
C34.92 Malignant neoplasm of unspecified part of left bronchus or lung

Pancreatic Cancer ICD-10 Codes

C25-C25.9 Malignant neoplasm of pancreas Copy

Salivary Gland Cancer ICD-10 Codes

C07 Copy Malignant neoplasm of parotid gland
C08 Copy Malignant neoplasm of other and unspecified major salivary glands
C08.0 Copy Malignant neoplasm of submandibular gland
C08.1 Copy Malignant neoplasm of sublingual gland
C08.9 Copy Malignant neoplasm of major salivary gland, unspecified

Sarcoma ICD-10 Codes

C47-C47.9 Copy Malignant neoplasm of peripheral nerves and autonomic nervous system
C48-C48.8 Copy Malignant neoplasm of retroperitoneum and peritoneum
C49-C49.9 Copy Malignant neoplasm of other connective and soft tissue
C49.A-C49.A9 Copy Gastrointestinal stromal tumor
C40-C40.92 Copy Malignant neoplasm of bone and articular cartilage of limbs
C41-C41.9 Copy Malignant neoplasm of bone and articular cartilage of other and unspecified sites

Thyroid Cancer ICD-10 Codes

C73 Copy Malignant neoplasm of thyroid gland

Melanoma ICD-10 Codes

C43-C43.9 Copy Malignant melanoma of skin

Primary Central Nervous System ICD-10 Codes

C71 Copy Malignant neoplasm of brain
C71.0 Copy Malignant neoplasm of cerebrum, except lobes and ventricles
C71.1 Copy Malignant neoplasm of frontal lobe
C71.2 Copy Malignant neoplasm of temporal lobe
C71.3 Copy Malignant neoplasm of parietal lobe
C71.4 Copy Malignant neoplasm of occipital lobe
C71.5 Copy Malignant neoplasm of cerebral ventricle
C71.6 Copy Malignant neoplasm of cerebellum
C71.7 Copy Malignant neoplasm of brain stem
C71.8 Copy Malignant neoplasm of overlapping sites of brain
C71.9 Copy Malignant neoplasm of brain, unspecified

Hepatocellular Cancer ICD-10 Codes

C22.0 Copy Liver cell carcinoma

Mesothelioma ICD-10 Codes

C45.0 Copy Mesothelioma of pleura
C45.1 Copy Mesothelioma of peritoneum

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 .

The HCP and patient are responsible for the accurate completion of documents regarding reimbursement or coverage. Bristol Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item. This is not a comprehensive list of ICD-10-CM codes.

*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.

CPT codes and descriptions only are ©2024 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:

  1. AUGTYRO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  2. American Medical Association. CPT® 2023 Professional Edition. Chicago, IL: American Medical Association; 2023.
  3. Centers for Medicare & Medicaid Services. ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/medicare/coding-billing/icd-10-codes/2024-icd-10-cm. Accessed March 27, 2024.

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 05/24.

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 Letters 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

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AUGTYRO for the treatment of adult and pediatric patients 12 years of age and older with solid tumors that have a neurotrophic tyrosine receptor kinase (NTRK) gene fusion and are locally advanced or metastatic or where surgical resection is likely to result in severe morbidity – Approved on 05/XX/2024

View Letter

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