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.

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  • 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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  • Use the BMS Access Map to identify plan-specific PA requirements
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  • 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 OPDIVO

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Healthcare Common Procedure Coding System (HCPCS) Codes1

Issued by CMS

OPDIVO
J9299 Copy Injection, nivolumab, 1 mg
J9299 Copy Injection, nivolumab, 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

YERVOY® (ipilimumab)
J9228 Copy Injection, ipilimumab, 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 Copy Drugs requiring detailed coding
0335 Copy Chemotherapy administration, IV
0260 Copy IV Therapy-General

Current Procedural Terminology (CPT)4,†

OPDIVO
96413 Copy Chemotherapy administration, IV intravenous infusion technique; up to 1 hour, single or initial substance/drug
YERVOY
96417 Copy Chemotherapy administration, IV infusion; each additional sequential infusion (different substance/drug), up to 1 hour (list separately in addition to code for primary procedure). (Use 96417 in conjunction with 96413)
96415 Copy Chemotherapy administration, IV infusion; each additional hour (list separately in addition to code for primary procedure). (Report 96415 for infusion intervals of greater than 30 minutes beyond 1-hour increments)
OPDIVO
96413 Copy Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
YERVOY
96417 Copy Chemotherapy administration, IV infusion; each additional sequential infusion (different substance/drug), up to 1 hour (list separately in addition to code for primary procedure). (Use 96417 in conjunction with 96413)
96415 Copy Chemotherapy administration, IV infusion; each additional hour (list separately in addition to code for primary procedure). (Report 96415 for infusion intervals of greater than 30 minutes beyond 1-hour increments)
OPDIVO
96413 Copy Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
YERVOY
96417 Copy Chemotherapy administration, IV infusion; each additional sequential infusion (different substance/drug), up to 1 hour (list separately in addition to code for primary procedure). (Use 96417 in conjunction with 96413)
96413 Copy Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug

National Drug Codes (NDC)5,6

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.

OPDIVO
00003-3772-11 Copy 40 mg/4 mL (10 mg/mL) single-dose vial
00003-3774-12 Copy 100 mg/10 mL (10 mg/mL) single-dose vial
00003-3756-14 Copy 120 mg/12 mL (10 mg/mL) single-dose vial
00003-3734-13 Copy 240 mg/24 mL (10 mg/mL) single-dose vial
YERVOY
00003-2327-11 Copy One 50 mg/10 mL (5 mg/mL), single-dose vial
00003-2328-22 Copy One 200 mg/40 mL (5 mg/mL), single-dose vial

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 Copy 40 mg/4 mL (10 mg/mL) single-dose vial
00003-3774-12 Copy 100 mg/10 mL (10 mg/mL) single-dose vial
00003-3756-14 Copy 120 mg/12 mL (10 mg/mL) single-dose vial
00003-3734-13 Copy 240 mg/24 mL (10 mg/mL) single-dose vial

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C64 Malignant neoplasm of kidney, except renal pelvis
C64.1 Malignant neoplasm of right kidney, except renal pelvis
C64.2 Malignant neoplasm of left kidney, except renal pelvis
C64.9 Malignant neoplasm of unspecified kidney, except renal pelvis
C65 Malignant neoplasm of renal pelvis
C65.1 Malignant neoplasm of right renal pelvis
C65.2 Malignant neoplasm of left renal pelvis
C65.9 Malignant neoplasm of unspecified renal pelvis
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.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)7

C64 Malignant neoplasm of kidney, except renal pelvis
C64.1 Malignant neoplasm of right kidney, except renal pelvis
C64.2 Malignant neoplasm of left kidney, except renal pelvis
C64.9 Malignant neoplasm of unspecified kidney, except renal pelvis
C65 Malignant neoplasm of renal pelvis
C65.1 Malignant neoplasm of right renal pelvis
C65.2 Malignant neoplasm of left renal pelvis
C65.9 Malignant neoplasm of unspecified renal pelvis
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.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C33 Malignant neoplasm of trachea
C34 Malignant neoplasm of bronchus and lung
C34.0 Malignant neoplasm of main bronchus, carina, and hilus of lung
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 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
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.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)7

C33 Malignant neoplasm of trachea
C34 Malignant neoplasm of bronchus and lung
C34.0 Malignant neoplasm of main bronchus, carina, and hilus of lung
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 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
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.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)7

C45 Mesothelioma
C45.0 Malignant mesothelioma of pleura

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C43 Copy Malignant melanoma of skin
C43.0 Copy Malignant melanoma of lip
C43.1 Copy Malignant melanoma of eyelid, including canthus
C43.10 Copy Malignant melanoma of unspecified eyelid, including canthus
C43.11 Copy Malignant melanoma of right eyelid, including canthus
C43.111 Copy Malignant melanoma of right upper eyelid, including canthus
C43.112 Copy Malignant melanoma of right lower eyelid, including canthus
C43.12 Copy Malignant melanoma of left eyelid, including canthus
C43.121 Copy Malignant melanoma of left upper eyelid, including canthus
C43.122 Copy Malignant melanoma of left lower eyelid, including canthus
C43.2 Copy Malignant melanoma of ear and external auricular canal
C43.20 Copy Malignant melanoma of unspecified ear and external auricular canal
C43.21 Copy Malignant melanoma of right ear and external auricular canal
C43.22 Copy Malignant melanoma of left ear and external auricular canal
C43.3 Copy Malignant melanoma of other and unspecified parts of face
C43.30 Copy Malignant melanoma of unspecified part of face
C43.31 Copy Malignant melanoma of nose
C43.39 Copy Malignant melanoma of other parts of face
C43.4 Copy Malignant melanoma of scalp and neck
C43.5 Copy Malignant melanoma of trunk
C43.51 Copy Malignant melanoma of anal skin
C43.52 Copy Malignant melanoma of skin of breast
C43.59 Copy Malignant melanoma of other part of trunk
C43.6 Copy Malignant melanoma of upper limb, including shoulder
C43.60 Copy Malignant melanoma of unspecified upper limb, including shoulder
C43.61 Copy Malignant melanoma of right upper limb, including shoulder
C43.62 Copy Malignant melanoma of left upper limb, including shoulder
C43.7 Copy Malignant melanoma of lower limb, including hip
C43.70 Copy Malignant melanoma of unspecified lower limb, including hip
C43.71 Copy Malignant melanoma of right lower limb, including hip
C43.72 Copy Malignant melanoma of left lower limb, including hip
C43.8 Copy Malignant melanoma of overlapping sites of skin
C43.9 Copy Malignant melanoma of skin, unspecified
C21 Copy Malignant neoplasm of anus and anal canal
C21.0 Copy Malignant neoplasm of anus, unspecified
C21.1 Copy Malignant neoplasm of anal canal
C51 Copy Malignant neoplasm of vulva
C51.0 Copy Malignant neoplasm of labium majus
C51.1 Copy Malignant neoplasm of labium minus
C51.2 Copy Malignant neoplasm of clitoris
C51.9 Copy Malignant neoplasm of vulva, unspecified
C52 Copy Malignant neoplasm of vagina
C57 Copy Malignant neoplasm of other and unspecified female genital organs
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
C60 Copy Malignant neoplasm of penis
C60.0 Copy Malignant neoplasm of prepuce
C60.1 Copy Malignant neoplasm of glans penis
C60.8 Copy Malignant neoplasm of overlapping sites of penis
C60.9 Copy Malignant neoplasm of penis, unspecified
C63 Copy Malignant neoplasm of other and unspecified male genital organs
C63.0 Copy Malignant neoplasm of epididymis
C63.00 Copy Malignant neoplasm of unspecified epididymis
C63.01 Copy Malignant neoplasm of right epididymis
C63.02 Copy Malignant neoplasm of left epididymis
C63.1 Copy Malignant neoplasm of spermatic cord
C63.10 Copy Malignant neoplasm of unspecified spermatic cord
C63.11 Copy Malignant neoplasm of right spermatic cord
C63.12 Copy Malignant neoplasm of left spermatic cord
C63.2 Copy Malignant neoplasm of scrotum
C63.7 Copy Malignant neoplasm of other specified male genital organs
C63.8 Copy Malignant neoplasm of overlapping sites of male genital organs
C63.9 Copy Malignant neoplasm of male genital organ, unspecified
Z51.12 Copy 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.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C43 Copy Malignant melanoma of skin
C43.0 Copy Malignant melanoma of lip
C43.1 Copy Malignant melanoma of eyelid, including canthus
C43.10 Copy Malignant melanoma of unspecified eyelid, including canthus
C43.11 Copy Malignant melanoma of right eyelid, including canthus
C43.111 Copy Malignant melanoma of right upper eyelid, including canthus
C43.112 Copy Malignant melanoma of right lower eyelid, including canthus
C43.12 Copy Malignant melanoma of left eyelid, including canthus
C43.121 Copy Malignant melanoma of left upper eyelid, including canthus
C43.122 Copy Malignant melanoma of left lower eyelid, including canthus
C43.2 Copy Malignant melanoma of ear and external auricular canal
C43.20 Copy Malignant melanoma of unspecified ear and external auricular canal
C43.21 Copy Malignant melanoma of right ear and external auricular canal
C43.22 Copy Malignant melanoma of left ear and external auricular canal
C43.3 Copy Malignant melanoma of other and unspecified parts of face
C43.30 Copy Malignant melanoma of unspecified part of face
C43.31 Copy Malignant melanoma of nose
C43.39 Copy Malignant melanoma of other parts of face
C43.4 Copy Malignant melanoma of scalp and neck
C43.5 Copy Malignant melanoma of trunk
C43.51 Copy Malignant melanoma of anal skin
C43.52 Copy Malignant melanoma of skin of breast
C43.59 Copy Malignant melanoma of other part of trunk
C43.6 Copy Malignant melanoma of upper limb, including shoulder
C43.60 Copy Malignant melanoma of unspecified upper limb, including shoulder
C43.61 Copy Malignant melanoma of right upper limb, including shoulder
C43.62 Copy Malignant melanoma of left upper limb, including shoulder
C43.7 Copy Malignant melanoma of lower limb, including hip
C43.70 Copy Malignant melanoma of unspecified lower limb, including hip
C43.71 Copy Malignant melanoma of right lower limb, including hip
C43.72 Copy Malignant melanoma of left lower limb, including hip
C43.8 Copy Malignant melanoma of overlapping sites of skin
C43.9 Copy Malignant melanoma of skin, unspecified
C21 Copy Malignant neoplasm of anus and anal canal
C21.0 Copy Malignant neoplasm of anus, unspecified
C21.1 Copy Malignant neoplasm of anal canal
C51 Copy Malignant neoplasm of vulva
C51.0 Copy Malignant neoplasm of labium majus
C51.1 Copy Malignant neoplasm of labium minus
C51.2 Copy Malignant neoplasm of clitoris
C51.9 Copy Malignant neoplasm of vulva, unspecified
C52 Copy Malignant neoplasm of vagina
C57 Copy Malignant neoplasm of other and unspecified female genital organs
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
C60 Copy Malignant neoplasm of penis
C60.0 Copy Malignant neoplasm of prepuce
C60.1 Copy Malignant neoplasm of glans penis
C60.8 Copy Malignant neoplasm of overlapping sites of penis
C60.9 Copy Malignant neoplasm of penis, unspecified
C63 Copy Malignant neoplasm of other and unspecified male genital organs
C63.0 Copy Malignant neoplasm of epididymis
C63.00 Copy Malignant neoplasm of unspecified epididymis
C63.01 Copy Malignant neoplasm of right epididymis
C63.02 Copy Malignant neoplasm of left epididymis
C63.1 Copy Malignant neoplasm of spermatic cord
C63.10 Copy Malignant neoplasm of unspecified spermatic cord
C63.11 Copy Malignant neoplasm of right spermatic cord
C63.12 Copy Malignant neoplasm of left spermatic cord
C63.2 Copy Malignant neoplasm of scrotum
C63.7 Copy Malignant neoplasm of other specified male genital organs
C63.8 Copy Malignant neoplasm of overlapping sites of male genital organs
C63.9 Copy Malignant neoplasm of male genital organ, unspecified
Z51.12 Copy 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.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C00 Copy Malignant neoplasm of lip
C00.0 Copy Malignant neoplasm of external upper lip
C00.1 Copy Malignant neoplasm of external lower lip
C00.2 Copy Malignant neoplasm of external lip, unspecified
C00.3 Copy Malignant neoplasm of upper lip, inner aspect
C00.4 Copy Malignant neoplasm of lower lip, inner aspect
C00.5 Copy Malignant neoplasm of lip, unspecified, inner aspect
C00.6 Copy Malignant neoplasm of commissure of lip, unspecified
C00.8 Copy Malignant neoplasm of overlapping sites of lip
C00.9 Copy Malignant neoplasm of lip, unspecified
C01 Copy Malignant neoplasm of base of tongue
C02 Copy Malignant neoplasm of other and unspecified parts of tongue
C02.0 Copy Malignant neoplasm of dorsal surface of tongue
C02.1 Copy Malignant neoplasm of border of tongue
C02.2 Copy Malignant neoplasm of ventral surface of tongue
C02.3 Copy Malignant neoplasm of anterior two-thirds of tongue, part unspecified
C02.4 Copy Malignant neoplasm of lingual tonsil
C02.8 Copy Malignant neoplasm of overlapping sites of tongue
C02.9 Copy Malignant neoplasm of tongue, unspecified
C03 Copy Malignant neoplasm of gum
C03.0 Copy Malignant neoplasm of upper gum
C03.1 Copy Malignant neoplasm of lower gum
C03.9 Copy Malignant neoplasm of gum, unspecified
C04 Copy Malignant neoplasm of floor of mouth
C04.0 Copy Malignant neoplasm of anterior floor of mouth
C04.1 Copy Malignant neoplasm of lateral floor of mouth
C04.8 Copy Malignant neoplasm of overlapping sites of floor of mouth
C04.9 Copy Malignant neoplasm of floor of mouth, unspecified
C05 Copy Malignant neoplasm of palate
C05.0 Copy Malignant neoplasm of hard palate
C05.1 Copy Malignant neoplasm of soft palate
C05.2 Copy Malignant neoplasm of uvula
C05.8 Copy Malignant neoplasm of overlapping sites of palate
C05.9 Copy Malignant neoplasm of palate, unspecified
C06 Copy Malignant neoplasm of other and unspecified parts of mouth
C06.0 Copy Malignant neoplasm of cheek mucosa
C06.1 Copy Malignant neoplasm of vestibule of mouth
C06.2 Copy Malignant neoplasm of retromolar area
C06.8 Copy Malignant neoplasm of overlapping sites of other and unspecified parts of mouth
C06.80 Copy Malignant neoplasm of overlapping sites of unspecified parts of mouth
C06.89 Copy Malignant neoplasm of overlapping sites of other parts of mouth
C06.9 Copy Malignant neoplasm of mouth, unspecified
C09 Copy Malignant neoplasm of tonsil
C09.0 Copy Malignant neoplasm of tonsillar fossa
C09.1 Copy Malignant neoplasm of tonsillar pillar (anterior) (posterior)
C09.8 Copy Malignant neoplasm of overlapping sites of tonsil
C09.9 Copy Malignant neoplasm of tonsil, unspecified
C10 Copy Malignant neoplasm of oropharynx
C10.0 Copy Malignant neoplasm of vallecula
C10.1 Copy Malignant neoplasm of anterior surface of epiglottis
C10.2 Copy Malignant neoplasm of lateral wall of oropharynx
C10.3 Copy Malignant neoplasm of posterior wall of oropharynx
C10.4 Copy Malignant neoplasm of branchial cleft
C10.8 Copy Malignant neoplasm of overlapping sites of oropharynx
C12 Copy Malignant neoplasm of pyriform sinus
C13 Copy Malignant neoplasm of hypopharynx
C13.0 Copy Malignant neoplasm of postcricoid region
C13.1 Copy Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect
C13.2 Copy Malignant neoplasm of posterior wall of hypopharynx
C13.8 Copy Malignant neoplasm of overlapping sites of hypopharynx
C13.9 Copy Malignant neoplasm of hypopharynx, unspecified
C14 Copy Malignant neoplasm of other and ill-defined sites in the lip, oral cavity and pharynx
C14.0 Copy Malignant neoplasm of pharynx, unspecified
C14.2 Copy Malignant neoplasm of Waldeyer’s ring
C14.8 Copy Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx
C32 Copy Malignant neoplasm of larynx
C32.0 Copy Malignant neoplasm of glottis
C32.1 Copy Malignant neoplasm of supraglottis
C32.2 Copy Malignant neoplasm of subglottis
C32.3 Copy Malignant neoplasm of laryngeal cartilage
C32.8 Copy Malignant neoplasm of overlapping sites of larynx
C32.9 Copy Malignant neoplasm of larynx, unspecified
C76 Copy Malignant neoplasm of other and ill-defined sites
C76.0 Copy Malignant neoplasm of head, face and neck
Z51.12 Copy 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.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

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
Z51.12 Copy 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.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)7

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
Z51.12 Copy 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.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C15 Copy Malignant neoplasm of esophagus
C15.5 Copy Malignant neoplasm of lower third of esophagus
C16 Copy Malignant neoplasm of stomach
C16.0 Copy Malignant neoplasm of cardia
C16.1 Copy Malignant neoplasm of fundus of stomach
C16.2 Copy Malignant neoplasm of body of stomach
C16.3 Copy Malignant neoplasm of pyloric antrum
C16.4 Copy Malignant neoplasm of pylorus
C16.5 Copy Malignant neoplasm of lesser curvature of stomach, unspecified
C16.6 Copy Malignant neoplasm of greater curvature of stomach, unspecified
C16.8 Copy Malignant neoplasm of overlapping sites of stomach
C16.9 Copy Malignant neoplasm of stomach, unspecified
Z51.12 Copy 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.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C65 Copy Malignant neoplasm of renal pelvis
C65.1 Copy Malignant neoplasm of right renal pelvis
C65.2 Copy Malignant neoplasm of left renal pelvis
C65.9 Copy Malignant neoplasm of unspecified renal pelvis
C66 Copy Malignant neoplasm of ureter
C66.1 Copy Malignant neoplasm of right ureter
C66.2 Copy Malignant neoplasm of left ureter
C66.9 Copy Malignant neoplasm of unspecified ureter
C67 Copy Malignant neoplasm of bladder
C67.0 Copy Malignant neoplasm of trigone of bladder
C67.1 Copy Malignant neoplasm of dome of bladder
C67.2 Copy Malignant neoplasm of lateral wall of bladder
C67.3 Copy Malignant neoplasm of anterior wall of bladder
C67.4 Copy Malignant neoplasm of posterior wall of bladder
C67.5 Copy Malignant neoplasm of bladder neck
C67.6 Copy Malignant neoplasm of ureteric orifice
C67.8 Copy Malignant neoplasm of overlapping sites of bladder
C67.9 Copy Malignant neoplasm of bladder, unspecified
C68 Copy Malignant neoplasm of other and unspecified urinary organs
C68.0 Copy Malignant neoplasm of urethra
C68.8 Copy Malignant neoplasm of overlapping sites of urinary organs
C68.9 Copy Malignant neoplasm of urinary organ, unspecified
Z51.12 Copy 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.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C65 Copy Malignant neoplasm of renal pelvis
C65.1 Copy Malignant neoplasm of right renal pelvis
C65.2 Copy Malignant neoplasm of left renal pelvis
C65.9 Copy Malignant neoplasm of unspecified renal pelvis
C66 Copy Malignant neoplasm of ureter
C66.1 Copy Malignant neoplasm of right ureter
C66.2 Copy Malignant neoplasm of left ureter
C66.9 Copy Malignant neoplasm of unspecified ureter
C67 Copy Malignant neoplasm of bladder
C67.0 Copy Malignant neoplasm of trigone of bladder
C67.1 Copy Malignant neoplasm of dome of bladder
C67.2 Copy Malignant neoplasm of lateral wall of bladder
C67.3 Copy Malignant neoplasm of anterior wall of bladder
C67.4 Copy Malignant neoplasm of posterior wall of bladder
C67.5 Copy Malignant neoplasm of bladder neck
C67.6 Copy Malignant neoplasm of ureteric orifice
C67.8 Copy Malignant neoplasm of overlapping sites of bladder
C67.9 Copy Malignant neoplasm of bladder, unspecified
C68 Copy Malignant neoplasm of other and unspecified urinary organs
C68.0 Copy Malignant neoplasm of urethra
C68.8 Copy Malignant neoplasm of overlapping sites of urinary organs
C68.9 Copy Malignant neoplasm of urinary organ, unspecified

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C15 Copy Malignant neoplasm of esophagus
C15.3 Copy Malignant neoplasm of upper third of esophagus
C15.4 Copy Malignant neoplasm of middle third of esophagus
C15.5 Copy Malignant neoplasm of lower third of esophagus
C15.8 Copy Malignant neoplasm of overlapping sites of esophagus
C15.9 Copy Malignant neoplasm of esophagus, unspecified
C16 Copy Malignant neoplasm of stomach
C16.0 Copy Malignant neoplasm of cardia
Z51.12 Copy 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.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C15 Copy Malignant neoplasm of esophagus
C15.3 Copy Malignant neoplasm of upper third of esophagus
C15.4 Copy Malignant neoplasm of middle third of esophagus
C15.5 Copy Malignant neoplasm of lower third of esophagus
C15.8 Copy Malignant neoplasm of overlapping sites of esophagus
C15.9 Copy Malignant neoplasm of esophagus, unspecified
Z51.12 Copy 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.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)7

C15 Copy Malignant neoplasm of esophagus
C15.3 Copy Malignant neoplasm of upper third of esophagus
C15.4 Copy Malignant neoplasm of middle third of esophagus
C15.5 Copy Malignant neoplasm of lower third of esophagus
C15.8 Copy Malignant neoplasm of overlapping sites of esophagus
C15.9 Copy Malignant neoplasm of esophagus, unspecified
Z51.12 Copy 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.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)7

C22 Malignant neoplasm of liver and intrahepatic bile ducts
C22.0 Liver cell carcinoma (hepatocellular carcinoma, hepatoma)
C22.8 Malignant neoplasm of liver, primary, unspecified as to type
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.

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6

C81 Copy Hodgkin lymphoma
C81.1 Copy Nodular sclerosis Hodgkin lymphoma
C81.10 Copy Nodular sclerosis Hodgkin lymphoma, unspecified site
C81.11 Copy Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.12 Copy Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes
C81.13 Copy Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes
C81.14 Copy Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.15 Copy Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.16 Copy Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes
C81.17 Copy Nodular sclerosis Hodgkin lymphoma, spleen
C81.18 Copy Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites
C81.19 Copy Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites
C81.2 Copy Mixed cellularity Hodgkin lymphoma
C81.20 Copy Mixed cellularity Hodgkin lymphoma, unspecified site
C81.21 Copy Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.22 Copy Mixed cellularity Hodgkin lymphoma, intrathoracic lymph nodes
C81.23 Copy Mixed cellularity Hodgkin lymphoma, intra-abdominal lymph nodes
C81.24 Copy Mixed cellularity Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.25 Copy Mixed cellularity Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.26 Copy Mixed cellularity Hodgkin lymphoma, intrapelvic lymph nodes
C81.27 Copy Mixed cellularity Hodgkin lymphoma, spleen
C81.28 Copy Mixed cellularity Hodgkin lymphoma, lymph nodes of multiple sites
C81.29 Copy Mixed cellularity Hodgkin lymphoma, extranodal and solid organ sites
C81.3 Copy Lymphocyte-depleted Hodgkin lymphoma
C81.30 Copy Lymphocyte-depleted Hodgkin lymphoma, unspecified site
C81.31 Copy Lymphocyte-depleted Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.32 Copy Lymphocyte-depleted Hodgkin lymphoma, intrathoracic lymph nodes
C81.33 Copy Lymphocyte-depleted Hodgkin lymphoma, intra-abdominal lymph nodes
C81.34 Copy Lymphocyte-depleted Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.35 Copy Lymphocyte-depleted Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.36 Copy Lymphocyte-depleted Hodgkin lymphoma, intrapelvic lymph nodes
C81.37 Copy Lymphocyte-depleted Hodgkin lymphoma, spleen
C81.38 Copy Lymphocyte-depleted Hodgkin lymphoma, lymph nodes of multiple sites
C81.39 Copy Lymphocyte-depleted Hodgkin lymphoma, extranodal and solid organ sites
C81.4 Copy Lymphocyte-rich Hodgkin lymphoma
C81.40 Copy Lymphocyte-rich Hodgkin lymphoma, unspecified site
C81.41 Copy Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.42 Copy Lymphocyte-rich Hodgkin lymphoma, intrathoracic lymph nodes
C81.43 Copy Lymphocyte-rich Hodgkin lymphoma, intra-abdominal lymph nodes
C81.44 Copy Lymphocyte-rich Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.45 Copy Lymphocyte-rich Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.46 Copy Lymphocyte-rich Hodgkin lymphoma, intrapelvic lymph nodes
C81.47 Copy Lymphocyte-rich Hodgkin lymphoma, spleen
C81.48 Copy Lymphocyte-rich Hodgkin lymphoma, lymph nodes of multiple sites
C81.49 Copy Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites
C81.7 Copy Other Hodgkin lymphoma
C81.70 Copy Other Hodgkin lymphoma, unspecified site
C81.71 Copy Other Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.72 Copy Other Hodgkin lymphoma, intrathoracic lymph nodes
C81.73 Copy Other Hodgkin lymphoma, intra-abdominal lymph nodes
C81.74 Copy Other Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.75 Copy Other Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.76 Copy Other Hodgkin lymphoma, intrapelvic lymph nodes
C81.77 Copy Other Hodgkin lymphoma, spleen
C81.78 Copy Other Hodgkin lymphoma, lymph nodes of multiple sites
C81.79 Copy Other Hodgkin lymphoma, extranodal and solid organ sites
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.
Z94.84 Stem cell transplant status
For patients who have had a stem cell transplant, add "Z94.84" as a secondary code.

Coding for OPDIVO and YERVOY 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.

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.

*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 ©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. 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 July 17, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 17, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. YERVOY [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  7. 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 July 17, 2023.

References:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 21, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 21, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. 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 July 21, 2023.

This is a category code and is invalid for stand-alone use.

References:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 21, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 21, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. YERVOY [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  7. 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 July 21, 2023.

This is a category code and is invalid for stand-alone use. Please select one of the expanded codes listed below.

The code C43 has an Excludes 2 note under it. Per ICD-10-CM official guidelines, an Excludes 2 note under a code represents “Not included here.” An Excludes 2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes 2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate. Under code C43, the Excludes 2 note lists the following:

  • Malignant melanoma of skin of genital organs (C51-C52, C60.-, C63.-)
  • Merkel cell carcinoma (C4A.-)
  • Sites other than skin – code to malignant neoplasm of the site

References:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 21, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 21, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. YERVOY [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  7. 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 July 21, 2023.

References:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 21, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 21, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. 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 July 21, 2023.

This is a category code and is invalid for stand-alone use.

References:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 21, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 21, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. 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 July 21, 2023.

This is a category code and is invalid for stand-alone use. Please select one of the expanded codes listed below.

The code C43 has an Excludes 2 note under it. Per ICD-10-CM official guidelines, an Excludes 2 note under a code represents “Not included here.” An Excludes 2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes 2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate. Under code C43, the Excludes 2 note lists the following:

  • Malignant melanoma of skin of genital organs (C51-C52, C60.-, C63.-)
  • Merkel cell carcinoma (C4A.-)
  • Sites other than skin – code to malignant neoplasm of the site

References:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 20, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 20, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. 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 July 20, 2023.

References:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 12, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 12, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. 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 July 12, 2023.

References:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 14, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 14, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. YERVOY [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  7. 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 July 14, 2023.

References:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 14, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 14, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. 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 July 14, 2023.

References:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 14, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 14, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. YERVOY [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  7. 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 July 14, 2023.

References:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 20, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 20, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. 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 July 20, 2023.

References:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 20, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 20, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. 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 July 20, 2023.

References:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 20, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 20, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. 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 July 20, 2023.

References:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 20, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 20, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. 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 July 20, 2023.

This is a category code and is invalid for stand-alone use. Please select one of the expanded codes listed below.

The code C43 has an Excludes 2 note under it. Per ICD-10-CM official guidelines, an Excludes 2 note under a code represents “Not included here.” An Excludes 2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes 2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate. Under code C43, the Excludes 2 note lists the following:

  • Malignant melanoma of skin of genital organs (C51-C52, C60.-, C63.-)
  • Merkel cell carcinoma (C4A.-)
  • Sites other than skin – code to malignant neoplasm of the site

References:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 20, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 20, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. YERVOY [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  7. 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 July 20, 2023.

This is a category code and is invalid for stand-alone use. Please select one of the expanded codes listed below.

The code C43 has an Excludes 2 note under it. Per ICD-10-CM official guidelines, an Excludes 2 note under a code represents “Not included here.” An Excludes 2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes 2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate. Under code C43, the Excludes 2 note lists the following:

  • Malignant melanoma of skin of genital organs (C51-C52, C60.-, C63.-)
  • Merkel cell carcinoma (C4A.-)
  • Sites other than skin – code to malignant neoplasm of the site

References:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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 July 20, 2023.
  3. Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 20, 2023.
  4. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  5. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  6. 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 July 20, 2023.

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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OPDIVO and YERVOY® (ipilimumab) may be purchased through the distributors listed below.

OPDIVO may be purchased through the distributors listed below.

Physician Offices

Specialty Distributor Phone Orders Fax Orders and Website
Besse Medical 1-888‑711‑5469
Monday-Friday
https://www.besse.com
Cardinal Health Specialty Pharmaceutical Distribution 1-877‑453‑3972
Monday-Friday (24-hour emergency on call)
https://specialtyonline.cardinalhealth.com
CuraScript Specialty Distribution 1‑877‑599‑7748
Monday-Friday
https://www.curascriptsd.com
McKesson Specialty Health 1‑800‑482‑6700
Monday-Friday
https://mscs.mckesson.com
Morris & Dickson Specialty 1‑800‑710‑6100
Monday-Friday
Fax: 1‑318‑524‑3096
https://www.mdspecialtydist.com
Oncology Supply 1‑800‑633‑7555
Monday-Friday
https://www.oncologysupply.com

For offices that prefer to use the services of a specialty pharmacy, specialty pharmacies can obtain OPDIVO and YERVOY from the distributors listed above.

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

Specialty Distributor Phone Orders Fax Orders and Website
ASD Healthcare 1‑800‑746‑6273
Monday-Friday
Fax: 1‑800‑547‑9413
https://www.asdhealthcare.com
Cardinal Health Specialty Pharmaceutical Distribution 1‑866‑677‑4844
Monday-Friday (24-hour emergency on call)
Fax: 1‑614‑553‑6301
https://orderexpress.cardinalhealth.com
DMS Pharmaceutical Group, Inc. 1‑877‑788‑1100
Monday-Friday
Fax: 1‑847‑518‑1105
www.dmspharma.com
McKesson Plasma and Biologics 1‑877‑625‑2566
Monday-Friday
Fax: 1‑888‑752‑7626
https://connect.mckesson.com
Morris & Dickson Specialty 1‑800‑710‑6100
Monday-Friday
Fax: 1‑318‑524‑3096
https://www.mdspecialtydist.com

Puerto Rico Hospitals and Oncology Clinics

Authorized Distributor Phone Orders Fax Orders and Website
Amerisource
Bergen Puerto Rico
1‑844‑222‑2273 https://abcorder.amerisourcebergen.com

Puerto Rico Hospitals and Oncology Clinics

Authorized Distributor Phone Orders Fax Orders and Website
Amerisource
Bergen Puerto Rico
1‑844‑222‑2273 https://abcorder.amerisourcebergen.com

Above information is accurate as of 10/23.

Above information is accurate as of 01/24.

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.

The OPDIVO and YERVOY distribution program includes extended payment terms to Bristol Myers Squibb authorized OPDIVO and YERVOY distributors. Healthcare providers and institutions should contact their OPDIVO and YERVOY distributor to understand specific payment terms that may be available to them from their distributor.

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Metastatic Non-Small Cell Lung Cancer

FDA Approval Letters as Posted by the FDA:

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OPDIVO, in combination with YERVOY® (ipilimumab), for the treatment of patients with unresectable or metastatic melanoma (indication simplification) – Approved on 03/07/2019

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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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OPDIVO for the treatment of patients with locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or have disease progression within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy – Approved on 02/02/2017

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Flat Dosing for OPDIVO (480 mg every 4 weeks) – Approved on 03/05/2018

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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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OPDIVO for the adjuvant treatment of patients with urothelial carcinoma (UC) who are at high risk of recurrence after undergoing radical resection of UC – Approved on 08/20/2021

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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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OPDIVO for patients with recurrent or metastatic squamous cell carcinoma of the head and neck with disease progression on or after platinum-based therapy – Approved on 11/10/2016

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Flat Dosing for OPDIVO (240 mg every 2 weeks) – Approved on 02/15/2018

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Flat Dosing for OPDIVO (480 mg every 4 weeks) – Approved on 03/05/2018

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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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OPDIVO for the treatment of patients with advanced renal cell carcinoma (RCC) who have received prior anti-angiogenic therapy – Approved on 11/23/2015

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Flat Dosing for OPDIVO (240 mg every 2 weeks) – Approved on 09/13/2016

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Flat Dosing for OPDIVO (480 mg every 4 weeks) – Approved on 03/05/2018

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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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OPDIVO in combination with YERVOY® (ipilimumab) for the first-line treatment of patients with intermediate or poor risk, advanced RCC – Approved on 04/16/2018

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OPDIVO in combination with cabozantinib for the first-line treatment of patients with advanced renal cell carcinoma (RCC) – Approved on 01/22/21

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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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OPDIVO for patients with metastatic non-squamous NSCLC who have progression on or after platinum-based chemotherapy* – Approved on 10/09/2015

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OPDIVO for patients with metastatic squamous NSCLC who have progression on or after platinum-based chemotherapy* – Approved on 03/04/2015

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Flat Dosing for OPDIVO (240 mg every 2 weeks) – Approved on 09/13/2016

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Flat Dosing for OPDIVO (480 mg every 4 weeks) – Approved on 03/05/2018

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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

View Letter
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OPDIVO for the treatment of patients with unresectable or metastatic melanoma (indication simplification) – Approved on 03/07/2019

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Flat Dosing for OPDIVO (240 mg every 2 weeks) – Approved on 09/13/2016

View Letter
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Flat Dosing for OPDIVO (480 mg every 4 weeks) – Approved on 03/05/2018

View Letter
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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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OPDIVO for the adjuvant treatment of adults and pediatric patients 12 years and older with melanoma with involvement of lymph nodes or metastatic disease who have undergone complete resection – Approved on 12/20/2017

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OPDIVO for the adjuvant treatment of adult and pediatric patients 12 years and older with completely resected Stages IIB, IIC, III, or IV melanoma – Approved on 10/13/2023

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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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OPDIVO for the adjuvant treatment of completely resected esophageal or gastroesophageal junction cancer with residual pathologic disease in patients who have received neoadjuvant chemoradiotherapy (CRT) – Approved on 05/20/2021

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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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OPDIVO for the treatment of adult patients with classical Hodgkin lymphoma (cHL) that has relapsed or progressed after autologous hematopoietic stem cell transplantation (HSCT) and brentuximab vedotin or after 3 or more lines of systemic therapy that includes autologous HSCT – Approved on 04/28/2017

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OPDIVO for the treatment of patients with cHL that has relapsed or progressed after autologous HSCT and post-transplantation brentuximab vedotin – Approved on 5/17/2016

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Flat Dosing for OPDIVO (240 mg every 2 weeks) – Approved on 02/15/2018

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Flat Dosing for OPDIVO (480 mg every 4 weeks) – Approved on 03/05/2018

View Letter
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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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OPDIVO, in combination with YERVOY® (ipilimumab), for the first-line treatment of adult patients with unresectable advanced or metastatic esophageal squamous cell carcinoma (ESCC) – Approved on 05/27/2022

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OPDIVO, in combination with fluoropyrimidine- and platinum-containing chemotherapy, for the first-line treatment of adult patients with unresectable advanced or metastatic esophageal squamous cell carcinoma (ESCC) – Approved on 05/27/2022

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OPDIVO for patients with unresectable advanced, recurrent, or metastatic esophageal squamous cell carcinoma (ESCC) after prior fluoropyrimidine- and platinum-based chemotherapy – Approved on 6/10/2020

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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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OPDIVO, in combination with fluoropyrimidine- and platinum-containing chemotherapy, for the treatment of patients with advanced or metastatic gastric cancer, gastroesophageal junction cancer, and esophageal adenocarcinoma – Approved on 4/16/2021

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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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OPDIVO in combination with YERVOY® (ipilimumab) for the treatment of patients with hepatocellular carcinoma who have been previously treated with sorafenib – Approved on 03/10/2020

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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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OPDIVO in combination with YERVOY® (ipilimumab) for adults and pediatric patients 12 years and older with MSI-H/dMMR metastatic colorectal cancer that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan – Approved on 07/10/2018

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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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OPDIVO for patients 12 years and older with MSI-H/dMMR metastatic colorectal cancer that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan – Approved on 07/31/2017

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Flat Dosing for OPDIVO (240 mg every 2 weeks) – Approved on 03/05/2018

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Flat Dosing for OPDIVO (240 mg every 2 weeks, or 480 mg every 4 weeks) – Approved on 04/18/2019

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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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OPDIVO in combination with YERVOY® (ipilimumab) for the first-line treatment of adult patients with unresectable malignant pleural mesothelioma – Approved on 10/02/2020

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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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OPDIVO in combination with YERVOY® (ipilimumab) for the first-line treatment of adult patients with metastatic non-small cell lung cancer whose tumors express PD-L1 (≥1%) as determined by an FDA-approved test, with no EGFR or ALK genomic tumor aberrations – Approved on 05/15/2020

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OPDIVO, in combination with YERVOY and 2 cycles of platinum-doublet chemotherapy, for the first-line treatment of adult patients with metastatic or recurrent non-small cell lung cancer, with no EGFR or ALK genomic tumor aberrations – Approved on 05/26/2020

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Availability of OPDIVO 120 mg vial – Approved on 08/27/2021

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Neoadjuvant Treatment of Resectable Non-Small Cell Lung Cancer

FDA Approval Letter as Posted by the FDA:

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OPDIVO, in combination with platinum-doublet chemotherapy, for neoadjuvant treatment of adult patients with resectable (tumors ≥ 4cm or node positive) non-small cell lung cancer – Approved on 03/04/2022

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*Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving OPDIVO.

dMMR=mismatch repair deficient; MSI-H=microsatellite instability high.

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UB-04/CMS-1450
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