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.
OPDIVO®
(nivolumab)
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.
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.1
Providers and suppliers are required to attest if there were no discarded amounts of drugs and biologicals.1
Healthcare Common Procedure Coding System (HCPCS) Codes2
Issued by CMS
| J9299 | Injection, nivolumab, 1 mg |
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 |
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.
| 00003-3772-11 | 40 mg/4 mL (10 mg/mL) single-dose vial |
| 00003-3774-12 | 100 mg/10 mL (10 mg/mL) single-dose vial |
| 00003-3756-14 | 120 mg/12 mL (10 mg/mL) single-dose vial |
| 00003-3734-13 | 240 mg/24 mL (10 mg/mL) single-dose vial |
International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6
Coding for OPDIVO 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 OPDIVO.
*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 ©2025 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.
‡This is a category code and is invalid for stand-alone use. Please select one of the expanded codes listed below.
References:
- Centers for Medicare & Medicaid Services. Discarded Drugs and Biologicals – JW Modifier and JZ Modifier Policy. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/JW-Modifier-FAQs.pdf. Accessed January 27, 2026.
- Centers for Medicare & Medicaid Services. 2026 ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/files/zip/2026-code-tables-tabular-and-index.zip. Accessed January 27, 2026.
- National Uniform Billing Committee (NUBC). Official UB-04 Data Specifications Manual 2020. Chicago, IL: American Hospital Association; 2020.
- American Medical Association. CPT 2025 Professional Edition. American Medical Association; 2024.
- OPDIVO® [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- Centers for Medicare & Medicaid Services. 2026 ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/files/zip/2026-code-tables-tabular-and-index.zip. Accessed January 27, 2026.
OPDIVO may be purchased through the distributors listed below.
Physician Offices
| Authorized Distributor | Phone & Fax Orders |
| Besse Medical > | Phone: 1-888‑711‑5469
|
| Cardinal Health Specialty Pharmaceutical Distribution > | Phone: 1-877‑453‑3972
|
| CuraScript Specialty Distribution > | Phone: 1‑877‑599‑7748
|
| HyGen Pharmaceuticals Specialty Division > | 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
|
| Oncology Supply > | Phone: 1‑800‑633‑7555
|
For offices that prefer to use the services of a specialty pharmacy, specialty pharmacies can obtain OPDIVO from the distributors listed above.
Hospitals and Infusion Centers
| Authorized 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
|
| HyGen Pharmaceuticals Specialty Division > | 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
|
Puerto Rico Hospitals and Clinics
| Authorized Distributor | Phone & Fax Orders |
| AmerisourceBergen Puerto Rico > | Phone: 1‑844‑222‑2273
|
Above information is accurate as of 01/26.
The OPDIVO distribution program includes extended payment terms to Bristol Myers Squibb authorized OPDIVO distributors. Healthcare providers and institutions should contact their OPDIVO distributor to understand specific payment terms that may be available to them from their distributor.
Please see U.S. Full Prescribing Information for OPDIVO.
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.
