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What is Health Insurance?
Welcome to Bristol Myers Squibb Access Support®
Discover how BMS Access Support may be able to help with the access and reimbursement process for BMS medications. To get started, confirm whether you’re a healthcare professional or patient or caregiver.
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Find easy-to-use forms, codes, and access and reimbursement information.
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
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.
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
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 OPDIVO
Select Your Patient’s Condition
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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
| 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
| 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.
Please see U.S. Full Prescribing Information for OPDIVO and YERVOY for complete indications.
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 ©2024 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 July 17, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 17, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- YERVOY [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- Centers for Medicare & Medicaid Services. ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/medicare/coding-billing/icd-10-codes/2023-icd-10-cm. Accessed July 17, 2023.
References:
- American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
- Centers for Medicare & Medicaid Services. MLN Matters, Number MM9603 Revised. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf. Revised June 10, 2016. Accessed July 21, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 21, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [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 July 21, 2023.
‡This is a category code and is invalid for stand-alone use.
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 July 21, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 21, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- YERVOY [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- Centers for Medicare & Medicaid Services. ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/medicare/coding-billing/icd-10-codes/2023-icd-10-cm. Accessed July 21, 2023.
‡This is a category code and is invalid for stand-alone use. Please select one of the expanded codes listed below.
The code C43 has an Excludes 2 note under it. Per ICD-10-CM official guidelines, an Excludes 2 note under a code represents “Not included here.” An Excludes 2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes 2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate. Under code C43, the Excludes 2 note lists the following:
- Malignant melanoma of skin of genital organs (C51-C52, C60.-, C63.-)
- Merkel cell carcinoma (C4A.-)
- Sites other than skin – code to malignant neoplasm of the site
References:
- American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
- Centers for Medicare & Medicaid Services. MLN Matters, Number MM9603 Revised. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf. Revised June 10, 2016. Accessed July 21, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 21, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- YERVOY [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 July 21, 2023.
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 July 21, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 21, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- Centers for Medicare & Medicaid Services. ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/medicare/coding-billing/icd-10-codes/2023-icd-10-cm. Accessed July 21, 2023.
‡This is a category code and is invalid for stand-alone use.
References:
- American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
- Centers for Medicare & Medicaid Services. MLN Matters, Number MM9603 Revised. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf. Revised June 10, 2016. Accessed July 21, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 21, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [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 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:
- 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 July 20, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 20, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- Centers for Medicare & Medicaid Services. ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/medicare/coding-billing/icd-10-codes/2023-icd-10-cm. Accessed July 20, 2023.
References:
- American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
- Centers for Medicare & Medicaid Services. MLN Matters, Number MM9603 Revised. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf. Revised June 10, 2016. Accessed July 12, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 12, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [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 July 12, 2023.
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 July 14, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 14, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- YERVOY [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- Centers for Medicare & Medicaid Services. ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/medicare/coding-billing/icd-10-codes/2023-icd-10-cm. Accessed July 14, 2023.
References:
- American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
- Centers for Medicare & Medicaid Services. MLN Matters, Number MM9603 Revised. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf. Revised June 10, 2016. Accessed July 14, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 14, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [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 July 14, 2023.
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 July 14, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 14, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- YERVOY [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- Centers for Medicare & Medicaid Services. ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/medicare/coding-billing/icd-10-codes/2023-icd-10-cm. Accessed July 14, 2023.
References:
- American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
- Centers for Medicare & Medicaid Services. MLN Matters, Number MM9603 Revised. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf. Revised June 10, 2016. Accessed July 20, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 20, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [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 July 20, 2023.
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 February 12, 2024.
- National Uniform Billing Committee (NUBC). Official UB-04 Data Specifications Manual 2020. Chicago, IL: American Hospital Association; 2020. Accessed February 12, 2024.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [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/2024-icd-10-cm. Accessed February 12, 2024.
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 July 20, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 20, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- Centers for Medicare & Medicaid Services. ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/medicare/coding-billing/icd-10-codes/2023-icd-10-cm. Accessed July 20, 2023.
References:
- American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
- Centers for Medicare & Medicaid Services. MLN Matters, Number MM9603 Revised. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf. Revised June 10, 2016. Accessed July 20, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 20, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [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 July 20, 2023.
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 July 20, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 20, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- Centers for Medicare & Medicaid Services. ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/medicare/coding-billing/icd-10-codes/2023-icd-10-cm. Accessed July 20, 2023.
‡This is a category code and is invalid for stand-alone use. Please select one of the expanded codes listed below.
The code C43 has an Excludes 2 note under it. Per ICD-10-CM official guidelines, an Excludes 2 note under a code represents “Not included here.” An Excludes 2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes 2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate. Under code C43, the Excludes 2 note lists the following:
- Malignant melanoma of skin of genital organs (C51-C52, C60.-, C63.-)
- Merkel cell carcinoma (C4A.-)
- Sites other than skin – code to malignant neoplasm of the site
References:
- American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
- Centers for Medicare & Medicaid Services. MLN Matters, Number MM9603 Revised. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf. Revised June 10, 2016. Accessed July 20, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed July 20, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- YERVOY [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 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:
- 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 July 20, 2023.
- 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.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO [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 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.
Select Your Patient’s Condition
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 |
| HyGen Pharmaceuticals Specialty Division | 1‑877‑630‑9198 Monday-Friday |
https://www.hygenpharma.com/#contactus |
| 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 |
| HyGen Pharmaceuticals Specialty Division | 1‑877‑630‑9198 Monday-Friday |
https://www.hygenpharma.com/#contactus |
| 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.
Above information is accurate as of 02/24.
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.
Please see U.S. Full Prescribing Information for OPDIVO.
Please see U.S. Full Prescribing Information for OPDIVO and YERVOY for complete indications.
Select Your Patient’s Condition
Metastatic Non-Small Cell Lung Cancer
FDA Approval Letters as Posted by the FDA:
OPDIVO, in combination with YERVOY® (ipilimumab), for the treatment of patients with unresectable or metastatic melanoma (indication simplification) – Approved on 03/07/2019
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
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
View Letter
Flat Dosing for OPDIVO (480 mg every 4 weeks) – Approved on 03/05/2018
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
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
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
OPDIVO, in combination with cisplatin and gemcitabine, is indicated for the first-line treatment of adult patients with unresectable or metastatic urothelial carcinoma – Approved on 03/06/2024
View Letter
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
View Letter
Flat Dosing for OPDIVO (240 mg every 2 weeks) – Approved on 02/15/2018
View Letter
Flat Dosing for OPDIVO (480 mg every 4 weeks) – Approved on 03/05/2018
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
OPDIVO for the treatment of patients with advanced renal cell carcinoma (RCC) who have received prior anti-angiogenic therapy – Approved on 11/23/2015
View Letter
Flat Dosing for OPDIVO (240 mg every 2 weeks) – Approved on 09/13/2016
View Letter
Flat Dosing for OPDIVO (480 mg every 4 weeks) – Approved on 03/05/2018
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
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
View Letter
OPDIVO in combination with cabozantinib for the first-line treatment of patients with advanced renal cell carcinoma (RCC) – Approved on 01/22/21
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
OPDIVO for patients with metastatic non-squamous NSCLC who have progression on or after platinum-based chemotherapy* – Approved on 10/09/2015
View Letter
OPDIVO for patients with metastatic squamous NSCLC who have progression on or after platinum-based chemotherapy* – Approved on 03/04/2015
View Letter
Flat Dosing for OPDIVO (240 mg every 2 weeks) – Approved on 09/13/2016
View Letter
Flat Dosing for OPDIVO (480 mg every 4 weeks) – Approved on 03/05/2018
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
OPDIVO for the treatment of patients with unresectable or metastatic melanoma (indication simplification) – Approved on 03/07/2019
View Letter
Flat Dosing for OPDIVO (240 mg every 2 weeks) – Approved on 09/13/2016
View Letter
Flat Dosing for OPDIVO (480 mg every 4 weeks) – Approved on 03/05/2018
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
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
View Letter
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
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
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
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
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
View Letter
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
View Letter
Flat Dosing for OPDIVO (240 mg every 2 weeks) – Approved on 02/15/2018
View Letter
Flat Dosing for OPDIVO (480 mg every 4 weeks) – Approved on 03/05/2018
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
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
View Letter
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
View Letter
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
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
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
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
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
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
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
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
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
View Letter
Flat Dosing for OPDIVO (240 mg every 2 weeks) – Approved on 03/05/2018
View Letter
Flat Dosing for OPDIVO (240 mg every 2 weeks, or 480 mg every 4 weeks) – Approved on 04/18/2019
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
OPDIVO in combination with YERVOY® (ipilimumab) for the first-line treatment of adult patients with unresectable malignant pleural mesothelioma – Approved on 10/02/2020
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View Letter
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
View Letter
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
View Letter
Availability of OPDIVO 120 mg vial – Approved on 08/27/2021
View LetterNeoadjuvant Treatment of Resectable Non-Small Cell Lung Cancer
FDA Approval Letter as Posted by the FDA:
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
View Letter*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.
Please see U.S. Full Prescribing Information for OPDIVO for complete indications.
Please see U.S. Full Prescribing Information for OPDIVO and YERVOY for complete indications.
Claim Forms for Outpatient Administration – Tutorial
Hospital Outpatient
UB-04/CMS-1450
Hospital Outpatient
UB-04/CMS-1450See Payer Policy Details
See Payer Policy Details
Learn about payer information by state for applicable treatments.
