Benefits Reviews
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.
EMPLICITI®
(elotuzumab)
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.
Healthcare Common Procedure Coding System (HCPCS) Codes1
Issued by CMS
| J9176 | Injection, elotuzumab, 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
Revenue Codes (for Use in the Hospital Outpatient Setting)3
| 0636 | Drugs requiring detailed coding |
| 0335 | Chemotherapy administration, IV |
| 0260 | IV Therapy-General |
Current Procedural Terminology (CPT)4,†
| 96413 | Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug |
| 96415 | Each additional hour
|
National Drug Codes (NDC)5
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.
| 00003-2291-11 | 300 mg single-dose vial |
| 00003-4522-11 | 400 mg single-dose vial |
International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6
| C90 | Multiple myeloma and malignant plasma cell neoplasms |
C90.0 |
Multiple myeloma |
| C90.00 | Multiple myeloma not having achieved remission |
| C90.02 | Multiple myeloma in relapse |
| Z51.12 | Encounter for antineoplastic immunotherapy 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. |
Coding for EMPLICITI is dependent on the insurer and the care setting in which the drug will be administered. Healthcare providers 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 EMPLICITI.
*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.
†CPT codes and descriptions only are ©2023 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:
- American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
- Centers for Medicare & Medicaid Services. MLN Matters, Number MM9603 Revised. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf. Revised June 10, 2016. Accessed August 2, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. March 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed August 2, 2023.
- American Medical Association. Current Procedural Terminology 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- EMPLICITI [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- 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. Accessed August 2, 2023.
EMPLICITI may be purchased through the distributors listed below.
Physician Offices
| Authorized Distributor | Phone & Fax Orders |
| Cardinal Health Specialty Pharmaceutical Distribution > | Phone: 1-877‑453‑3972
|
| CuraScript Specialty Distribution > | Phone: 1‑877‑599‑7748
|
| McKesson Specialty Health > | Phone: 1‑800‑482‑6700
|
| Morris & Dickson Specialty > | Phone: 1‑800‑710‑6100
Fax: 1‑318‑524‑3096
|
| Oncology Supply > | Phone: 1‑800‑633‑7555
|
For offices that prefer to use the services of a specialty pharmacy, specialty pharmacies can obtain EMPLICITI from the below-listed distributors.
Hospitals and Infusion Centers
| Specialty Distributor | Phone & Fax Orders |
| ASD Healthcare > | Phone: 1-800-746-6273
Fax: 1-800-547-9413
|
| Cardinal Health Specialty Pharmaceutical Distribution > | Phone: 1-866-677-4844
Fax: 1-614-553-6301
|
| DMS Pharmaceutical Group, Inc. > | Phone: 1-877-788-1100
Fax: 1-847-518-1105
|
| McKesson Plasma and Biologics > | Phone: 1-877-625-2566
Fax: 1-888-752-7626
|
| Morris & Dickson Specialty > | Phone: 1-800-710-6100
Fax: 1-318-524-3096
|
Puerto Rico Hospitals and Clinics
| Authorized Distributor | Phone & Fax Orders |
| AmerisourceBergen Puerto Rico > | Phone: 1-844-222-2273 |
| Cardinal Puerto Rico (Borschow) > | Phone: 1-787-625-4200
|
| Cesar Castillo, Inc. > | Phone: 1-787-641-5242 (Hospitals)
Phone: 1-787-641-5082 (Specialty Pharmacies)
Fax: 1-787-999-1614
|
Above information is accurate as of 01/26.
The EMPLICITI distribution program includes extended payment terms to Bristol Myers Squibb authorized EMPLICITI distributors. Healthcare providers and institutions should contact their EMPLICITI distributor to understand specific payment terms that may be available to them from their distributor.
Please see U.S. Full Prescribing Information for EMPLICITI.
FDA Approval Letters as Posted by the FDA:
FDA Letter — in combination with pomalidomide and dexamethasone for the treatment of adult patients with multiple myeloma after at least two prior therapies including lenalidomide and a proteasome inhibitor
FDA Letter — in combination with lenalidomide and dexamethasone for the treatment of adult patients with multiple myeloma after one to three prior therapies
Please see U.S. Full Prescribing Information for EMPLICITI.
Claim Forms for Outpatient Administration
Sample CMS-1500
Physician Office
Sample UB-04/CMS-1450
Hospital Outpatient
See Payer Policy Details
Learn about payer information by state for applicable treatments.
