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.

Click here to learn more about our coverage & reimbursement support

Benefits Reviews

Once a patient is enrolled in BMS Access Support, we can review their insurance coverage
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

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

NULOJIX^®

(belatacept)

Indication(s)

Important Safety Information

U.S. Full Prescribing Information, including BOXED WARNINGS

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 NULOJIX

Explore codes on this page: ⬇HCPCS ⬇CPT ⬇NDC ⬇ICD-10

Healthcare Common Procedure Coding System (HCPCS) Codes¹

Issued by CMS

J0485

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	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96365	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

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

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:

American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
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.
American Medical Association. Current Procedural Terminology 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
NULOJIX [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.

NULOJIX may be purchased through the approved distributor listed below:

Physician Offices

Wholesaler	Phone & Fax Orders
Cardinal Health Specialty Pharmaceutical Distribution >	Phone: 1-877-453-3972
CuraScript Specialty Distribution >	Phone: 1-877-599-7748
HyGen Specialty >	Phone: 1-877-630-9198
McKesson Specialty Health >	Phone: 1-800-482-6700
Morris & Dickson Specialty >	Phone: 1-800-710-6100 Fax: 1-318-524-3096

Hospitals and Infusion Centers

Wholesaler	Phone & Fax Orders
ASD Healthcare >	Phone: 1-800-746-6273 Fax: 1-800-547-9413
BioCare SD >	Phone: 1-800-304-3064
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
HyGen Specialty >	Phone: 1-877-630-9198
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
Besse Medical	Phone: 1-888-711-5469

Optum Specialty Pharmacy

Wholesaler	Phone & Fax Orders
Optum Specialty Distribution	Phone: 1-855-427-4682

Above information is accurate as of 01/26.

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

Blank CMS-1500
Physician Office

Blank UB-04/CMS-1450
Hospital Outpatient