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 NULOJIX

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Healthcare Common Procedure Coding System (HCPCS) Codes1

Issued by CMS

J0485 Copy Injection, belatacept, 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

Current Procedural Terminology (CPT)3,†

96413 Copy Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96365 Copy Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour

National Drug Codes (NDC)4

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.

00003-0371-13 Copy One 250-mg vial, single use; one 12-mL syringe

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)5

Z94.0 Copy Kidney transplant status

Please see U.S. Full Prescribing Information for NULOJIX, 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.

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:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. Medicare Claims Processing Manual. Chapter 17 – Drugs and Biologicals Revision 11572, August 25, 2022. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c17.pdf. Accessed August 10, 2023.
  3. American Medical Association. Current Procedural Terminology 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  4. NULOJIX [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  5. 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.

NULOJIX may be purchased through the approved distributor listed below:

Wholesaler Phone Orders Website
McKesson Plasma and Biologics 1‑877‑625‑2566 https://connect.mckesson.com

Above information is accurate as of 12/23.

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

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

Claim Forms for Outpatient Administration

Physician Office
CMS-1500
Hospital Outpatient
UB-04/CMS-1450