Benefits Reviews
Codes and Coverage
Supporting patient access
BMS Access Support® may help support patient access by conducting benefits reviews and offering prior authorization and appeals process assistance for enrolled patients. Additionally, the information below provides product-specific billing and diagnosis codes, reimbursement and coding guides, distribution information, and additional coverage support offerings. To view available coding and coverage information, please select your patient’s prescribed medication.
Additional eligibility criteria and terms may apply. Bristol Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.
- Once a patient is enrolled in BMS Access Support, we can review their insurance coverage
- A benefits review may help determine whether or not a medication is covered, if a PA is required, and estimated patient out-of-pocket costs
Prior Authorization (PA) and Appeals Assistance
- Use the BMS Access Map to identify plan-specific PA requirements
- View our forms and resources page for helpful support tools, including appeals letter templates and medical necessity letters
Annual Reverification
- Reverification of benefits is available upon request to confirm a patient’s benefits for the new year
- Connect with your local Access and Reimbursement Manager for more information
OPDIVO®
(nivolumab)
The accurate completion of reimbursement- or coverage-related documentation is the responsibility of the healthcare provider and patient. Bristol Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.
Providers and suppliers are required to report the JW modifier on Part B drug claims for discarded drugs and biologicals. Also, providers and suppliers must document the amount of discarded drugs or biologicals in Medicare beneficiaries’ medical records.1
Providers and suppliers are required to attest if there were no discarded amounts of drugs and biologicals.1
Healthcare Common Procedure Coding System (HCPCS) Codes2
Issued by CMS
| J9299 | Injection, nivolumab, 1 mg |
Revenue Codes (for Use in the Hospital Outpatient Setting)3
| 0636 | Drugs requiring detailed coding |
| 0335 | Chemotherapy administration, IV |
| 0260 | IV Therapy-General |
Current Procedural Terminology (CPT)4,†
| 96413 | Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug |
National Drug Codes (NDC)5
Issued by the FDA
Note: Payers require the submission of the 11-digit NDC on healthcare claim forms. Please use the 11-digit codes shown here.
| 00003-3772-11 | 40 mg/4 mL (10 mg/mL) single-dose vial |
| 00003-3774-12 | 100 mg/10 mL (10 mg/mL) single-dose vial |
| 00003-3756-14 | 120 mg/12 mL (10 mg/mL) single-dose vial |
| 00003-3734-13 | 240 mg/24 mL (10 mg/mL) single-dose vial |
International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6
| C43 | Malignant melanoma of skin |
| C43.0 | Malignant melanoma of lip |
| C43.1‡ | Malignant melanoma of eyelid, including canthus |
| C43.10 | Malignant melanoma of unspecified eyelid, including canthus |
| C43.11‡ | Malignant melanoma of right eyelid, including canthus |
| C43.111 | Malignant melanoma of right upper eyelid, including canthus |
| C43.112 | Malignant melanoma of right lower eyelid, including canthus |
| C43.12‡ | Malignant melanoma of left eyelid, including canthus |
| C43.121 | Malignant melanoma of left upper eyelid, including canthus |
| C43.122 | Malignant melanoma of left lower eyelid, including canthus |
| C43.2‡ | Malignant melanoma of ear and external auricular canal |
| C43.20 | Malignant melanoma of unspecified ear and external auricular canal |
| C43.21 | Malignant melanoma of right ear and external auricular canal |
| C43.22 | Malignant melanoma of left ear and external auricular canal |
| C43.3‡ | Malignant melanoma of other and unspecified parts of face |
| C43.30 | Malignant melanoma of unspecified part of face |
| C43.31 | Malignant melanoma of nose |
| C43.39 | Malignant melanoma of other parts of face |
| C43.4 | Malignant melanoma of scalp and neck |
| C43.5‡ | Malignant melanoma of trunk |
| C43.51 | Malignant melanoma of anal skin |
| C43.52 | Malignant melanoma of skin of breast |
| C43.59 | Malignant melanoma of other part of trunk |
| C43.6‡ | Malignant melanoma of upper limb, including shoulder |
| C43.60 | Malignant melanoma of unspecified upper limb, including shoulder |
| C43.61 | Malignant melanoma of right upper limb, including shoulder |
| C43.61 | Malignant melanoma of other parts of face |
| C43.7‡ | Malignant melanoma of lower limb, including hip |
| C43.70 | Malignant melanoma of unspecified lower limb, including hip |
| C43.71 | Malignant melanoma of right lower limb, including hip |
| C43.72 | Malignant melanoma of left lower limb, including hip |
| C43.8 | Malignant melanoma of overlapping sites of skin |
| C43.9 | Malignant melanoma of skin, unspecified |
| C21 | Malignant neoplasm of anus and anal canal |
| C21.0 | Malignant neoplasm of anus, unspecified |
| C21.1 | Malignant neoplasm of anal canal |
| C51 | Malignant neoplasm of vulva |
| C51.0 | Malignant neoplasm of labium majus |
| C51.1 | Malignant neoplasm of labium minus |
| C51.2 | Malignant neoplasm of clitoris |
| C51.9 | Malignant neoplasm of vulva, unspecified |
| C52 | Malignant neoplasm of vagina |
| C57 | Malignant neoplasm of other and unspecified female genital organs |
| C57.7 | Malignant neoplasm of other specified female genital organs |
| C57.8 | Malignant neoplasm of overlapping sites of female genital organs |
| C57.9 | Malignant neoplasm of female genital organ, unspecified |
| C60 | Malignant neoplasm of penis |
| C60.0 | Malignant neoplasm of prepuce |
| C60.1 | Malignant neoplasm of glans penis |
| C60.8 | Malignant neoplasm of overlapping sites of penis |
| C60.9 | Malignant neoplasm of penis, unspecified |
| C63 | Malignant neoplasm of other and unspecified male genital organs |
| C63.0‡ | Malignant neoplasm of epididymis |
| C63.00 | Malignant neoplasm of unspecified epididymis |
| C63.01 | Malignant neoplasm of right epididymis |
| C63.02 | Malignant neoplasm of left epididymis |
| C63.1‡ | Malignant neoplasm of spermatic cord |
| C63.10 | Malignant neoplasm of unspecified spermatic cord |
| C63.11 | Malignant neoplasm of right spermatic cord |
| C63.12 | Malignant neoplasm of left spermatic cord |
| C63.2 | Malignant neoplasm of scrotum |
| C63.7 | Malignant neoplasm of other specified male genital organs |
| C63.8 | Malignant neoplasm of overlapping sites of male genital organs |
| C63.9 | Malignant neoplasm of male genital organ, unspecified |
| Z51.12 | Encounter for antineoplastic immunotherapy |
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
| 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 unspecified part of bronchus or 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 |
| C45 | Mesothelioma |
| C45.0 | Malignant mesothelioma of pleura |
| Z51.12 | Encounter for antineoplastic immunotherapy |
| 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 |
| C81 | Hodgkin lymphoma |
| C81.1‡ | Nodular sclerosis Hodgkin lymphoma |
| C81.10 | Nodular sclerosis Hodgkin lymphoma, unspecified site |
| C81.11 | Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.12 | Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes |
| C81.13 | Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.14 | Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.15 | Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.16 | Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes |
| C81.17 | Nodular sclerosis Hodgkin lymphoma, spleen |
| C81.18 | Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites |
| C81.19 | Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites |
| C81.2‡ | Mixed cellularity Hodgkin lymphoma |
| C81.20 | Mixed cellularity Hodgkin lymphoma, unspecified site |
| C81.21 | Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.22 | Mixed cellularity Hodgkin lymphoma, intrathoracic lymph nodes |
| C81.23 | Mixed cellularity Hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.24 | Mixed cellularity Hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.25 | Mixed cellularity Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.26 | Mixed cellularity Hodgkin lymphoma, intrapelvic lymph nodes |
| C81.27 | Mixed cellularity Hodgkin lymphoma, spleen |
| C81.28 | Mixed cellularity Hodgkin lymphoma, lymph nodes of multiple sites |
| C81.29 | Mixed cellularity Hodgkin lymphoma, extranodal and solid organ sites |
| C81.3‡ | Lymphocyte depleted Hodgkin lymphoma |
| C81.30 | Lymphocyte depleted Hodgkin lymphoma, unspecified site |
| C81.31 | Lymphocyte depleted Hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.32 | Lymphocyte depleted Hodgkin lymphoma, intrathoracic lymph nodes |
| C81.33 | Lymphocyte depleted Hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.34 | Lymphocyte depleted Hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.35 | Lymphocyte depleted Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.36 | Lymphocyte depleted Hodgkin lymphoma, intrapelvic lymph nodes |
| C81.37 | Lymphocyte depleted Hodgkin lymphoma, spleen |
| C81.38 | Lymphocyte depleted Hodgkin lymphoma, lymph nodes of multiple sites |
| C81.39 | Lymphocyte depleted Hodgkin lymphoma, extranodal and solid organ sites |
| C81.4‡ | Lymphocyte-rich Hodgkin lymphoma |
| C81.40 | Lymphocyte-rich Hodgkin lymphoma, unspecified site |
| C81.41 | Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.42 | Lymphocyte-rich Hodgkin lymphoma, intrathoracic lymph nodes |
| C81.43 | Lymphocyte-rich Hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.44 | Lymphocyte-rich Hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.45 | Lymphocyte-rich Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.46 | Lymphocyte-rich Hodgkin lymphoma, intrapelvic lymph nodes |
| C81.47 | Lymphocyte-rich Hodgkin lymphoma, spleen |
| C81.48 | Lymphocyte-rich Hodgkin lymphoma, lymph nodes of multiple sites |
| C81.49 | Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites |
| C81.7‡ | Other Hodgkin lymphoma |
| C81.70 | Other Hodgkin lymphoma, unspecified site |
| C81.71 | Other Hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.72 | Other Hodgkin lymphoma, intrathoracic lymph nodes |
| C81.73 | Other Hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.74 | Other Hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.75 | Other Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.76 | Other Hodgkin lymphoma, intrapelvic lymph nodes |
| C81.77 | Other Hodgkin lymphoma, spleen |
| C81.78 | Other Hodgkin lymphoma, lymph nodes of multiple sites |
| C81.79 | Other Hodgkin lymphoma, extranodal and solid organ sites |
| Z94.84 | Stem cell transplant status |
| Z51.12 | Encounter for antineoplastic immunotherapy |
| C00 | Malignant neoplasm of lip |
| C00.0 | Malignant neoplasm of external upper lip |
| C00.1 | Malignant neoplasm of external lower lip |
| C00.2 | Malignant neoplasm of external lip, unspecified |
| C00.3 | Malignant neoplasm of upper lip, inner aspect |
| C00.4 | Malignant neoplasm of lower lip, inner aspect |
| C00.5 | Malignant neoplasm of lip, unspecified, inner aspect |
| C00.6 | Malignant neoplasm of commissure of lip, unspecified |
| C00.8 | Malignant neoplasm of overlapping sites of lip |
| C00.9 | Malignant neoplasm of lip, unspecified |
| C01 | Malignant neoplasm of base of tongue |
| C02 | Malignant neoplasm of other and unspecified parts of tongue |
| C02.0 | Malignant neoplasm of dorsal surface of tongue |
| C02.1 | Malignant neoplasm of border of tongue |
| C02.2 | Malignant neoplasm of ventral surface of tongue |
| C02.3 | Malignant neoplasm of anterior two-thirds of tongue, part unspecified |
| C02.4 | Malignant neoplasm of lingual tonsil |
| C02.8 | Malignant neoplasm of overlapping sites of tongue |
| C02.9 | Malignant neoplasm of tongue, unspecified |
| C03 | Malignant neoplasm of gum |
| C03.0 | Malignant neoplasm of upper gum |
| C03.1 | Malignant neoplasm of lower gum |
| C03.9 | Malignant neoplasm of gum, unspecified |
| C04 | Malignant neoplasm of floor of mouth |
| C04.0 | Malignant neoplasm of anterior floor of mouth |
| C04.1 | Malignant neoplasm of lateral floor of mouth |
| C04.8 | Malignant neoplasm of overlapping sites of floor of mouth |
| C04.9 | Malignant neoplasm of floor of mouth, unspecified |
| C05 | Malignant neoplasm of palate |
| C05.0 | Malignant neoplasm of hard palate |
| C05.1 | Malignant neoplasm of soft palate |
| C05.2 | Malignant neoplasm of uvula |
| C05.8 | Malignant neoplasm of overlapping sites of palate |
| C05.9 | Malignant neoplasm of palate, unspecified |
| C06 | Malignant neoplasm of other and unspecified parts of mouth |
| C06.0 | Malignant neoplasm of cheek mucosa |
| C06.1 | Malignant neoplasm of vestibule of mouth |
| C06.2 | Malignant neoplasm of retromolar area |
| C06.8‡ | Malignant neoplasm of overlapping sites of other and unspecified parts of mouth |
| C06.80 | Malignant neoplasm of overlapping sites of unspecified parts of mouth |
| C06.89 | Malignant neoplasm of overlapping sites of other parts of mouth |
| C06.9 | Malignant neoplasm of mouth, unspecified |
| C09 | Malignant neoplasm of tonsil |
| C09.0 | Malignant neoplasm of tonsillar fossa |
| C09.1 | Malignant neoplasm of tonsillar pillar (anterior) (posterior) |
| C09.8 | Malignant neoplasm of overlapping sites of tonsil |
| C09.9 | Malignant neoplasm of tonsil, unspecified |
| C10 | Malignant neoplasm of oropharynx |
| C10.0 | Malignant neoplasm of vallecula |
| C10.1 | Malignant neoplasm of anterior surface of epiglottis |
| C10.2 | Malignant neoplasm of lateral wall of oropharynx |
| C10.3 | Malignant neoplasm of posterior wall of oropharynx |
| C10.4 | Malignant neoplasm of branchial cleft |
| C10.8 | Malignant neoplasm of overlapping sites of oropharynx |
| C12 | Malignant neoplasm of pyriform sinus |
| C13 | Malignant neoplasm of hypopharynx |
| C13.0 | Malignant neoplasm of postcricoid region |
| C13.1 | Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect |
| C13.2 | Malignant neoplasm of posterior wall of hypopharynx |
| C13.8 | Malignant neoplasm of overlapping sites of hypopharynx |
| C13.9 | Malignant neoplasm of hypopharynx, unspecified |
| C14 | Malignant neoplasm of other and ill-defined sites in the lip, oral cavity and pharynx |
| C14.0 | Malignant neoplasm of pharynx, unspecified |
| C14.2 | Malignant neoplasm of Waldeyer’s ring |
| C14.8 | Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx |
| C32 | Malignant neoplasm of larynx |
| C32.0 | Malignant neoplasm of glottis |
| C32.1 | Malignant neoplasm of supraglottis |
| C32.2 | Malignant neoplasm of subglottis |
| C32.3 | Malignant neoplasm of laryngeal cartilage |
| C32.8 | Malignant neoplasm of overlapping sites of larynx |
| C32.9 | Malignant neoplasm of larynx, unspecified |
| C76 | Malignant neoplasm of other and ill-defined sites |
| C76.0 | Malignant neoplasm of head, face and neck |
| Z51.12 | Encounter for antineoplastic immunotherapy |
| 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 |
| C66 | Malignant neoplasm of ureter |
| C66.1 | Malignant neoplasm of right ureter |
| C66.2 | Malignant neoplasm of left ureter |
| C66.9 | Malignant neoplasm of unspecified ureter |
| C67 | Malignant neoplasm of bladder |
| C67.0 | Malignant neoplasm of trigone of bladder |
| C67.1 | Malignant neoplasm of dome of bladder |
| C67.2 | Malignant neoplasm of lateral wall of bladder |
| C67.3 | Malignant neoplasm of anterior wall of bladder |
| C67.4 | Malignant neoplasm of posterior wall of bladder |
| C67.5 | Malignant neoplasm of bladder neck |
| C67.6 | Malignant neoplasm of ureteric orifice |
| C67.8 | Malignant neoplasm of overlapping sites of bladder |
| C67.9 | Malignant neoplasm of bladder, unspecified |
| C68 | Malignant neoplasm of other and unspecified urinary organs |
| C68.0 | Malignant neoplasm of urethra |
| C68.8 | Malignant neoplasm of overlapping sites of urinary organs |
| C68.9 | Malignant neoplasm of urinary organ, unspecified |
| Z51.12 | Encounter for antineoplastic immunotherapy |
| C18 | Malignant neoplasm of colon |
| C18.0 | Malignant neoplasm of cecum |
| C18.1 | Malignant neoplasm of appendix |
| C18.2 | Malignant neoplasm of ascending colon |
| C18.3 | Malignant neoplasm of hepatic flexure |
| C18.4 | Malignant neoplasm of transverse colon |
| C18.5 | Malignant neoplasm of splenic flexure |
| C18.6 | Malignant neoplasm of descending colon |
| C18.7 | Malignant neoplasm of sigmoid colon |
| C18.8 | Malignant neoplasm of overlapping sites of colon |
| C18.9 | Malignant neoplasm of colon, unspecified |
| C19 | Malignant neoplasm of rectosigmoid junction |
| C20 | Malignant neoplasm of rectum |
| Z51.12 | Encounter for antineoplastic immunotherapy |
| 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 |
Advanced ESCC
| C15 | Malignant neoplasm of esophagus |
| C15.3 | Malignant neoplasm of upper third of esophagus |
| C15.4 | Malignant neoplasm of middle third of esophagus |
| C15.5 | Malignant neoplasm of lower third of esophagus |
| C15.8 | Malignant neoplasm of overlapping sites of esophagus |
| C15.9 | Malignant neoplasm of esophagus, unspecified |
Adjuvant Treatment of EC or GEJC
| C15 | Malignant neoplasm of esophagus |
| C15.3 | Malignant neoplasm of upper third of esophagus |
| C15.4 | Malignant neoplasm of middle third of esophagus |
| C15.5 | Malignant neoplasm of lower third of esophagus |
| C15.8 | Malignant neoplasm of overlapping sites of esophagus |
| C15.9 | Malignant neoplasm of esophagus, unspecified |
| C16 | Malignant neoplasm of stomach (gastroesophageal junction) |
| C16.0 | Malignant neoplasm of cardia Malignant neoplasm of cardiac orifice Malignant neoplasm of cardio-esophageal junction Malignant neoplasm of esophagus and stomach Malignant neoplasm of gastro-esophageal junction |
1L Metastatic ESCC
| C15 | Malignant neoplasm of esophagus |
| C15.3 | Malignant neoplasm of upper third of esophagus |
| C15.4 | Malignant neoplasm of middle third of esophagus |
| C15.5 | Malignant neoplasm of lower third of esophagus |
| C15.8 | Malignant neoplasm of overlapping sites of esophagus |
| C15.9 | Malignant neoplasm of esophagus, unspecified |
Advanced or Metastatic Gastric, GEJ, and Esophageal Adenocarcinoma
| C15 | Malignant neoplasm of esophagus |
| C15.3 | Malignant neoplasm of upper third of esophagus |
| C15.4 | Malignant neoplasm of middle third of esophagus |
| C15.5 | Malignant neoplasm of lower third of esophagus |
| C15.8 | Malignant neoplasm of overlapping sites of esophagus |
| C15.9 | Malignant neoplasm of esophagus, unspecified |
| C16 | Malignant neoplasm of stomach (gastroesophageal junction) |
| C16.0 | Malignant neoplasm of cardia Malignant neoplasm of cardiac orifice Malignant neoplasm of cardio-esophageal junction Malignant neoplasm of esophagus and stomach Malignant neoplasm of gastro-esophageal junction |
| C16.1 | Malignant neoplasm of fundus of stomach |
| C16.2 | Malignant neoplasm of body of stomach |
| C16.3 | Malignant neoplasm of pyloric antrum |
| C16.4 | Malignant neoplasm of pylorus |
| C16.5 | Malignant neoplasm of lesser curvature of stomach, unspecified |
| C16.6 | Malignant neoplasm of greater curvature of stomach, unspecified |
| C16.8 | Malignant neoplasm of overlapping sites of stomach |
| C16.9 | Malignant neoplasm of stomach, unspecified |
| Z51.12 | Encounter for antineoplastic immunotherapy |
Coding for OPDIVO is dependent on the insurer and the care setting in which the drug will be administered. Oncology practices need to make coding decisions based on the diagnosis and treatment of each patient and the specific insurer requirements.
Please see U.S. Full Prescribing Information for OPDIVO.
*Healthcare providers should code healthcare claims based upon the service that is rendered, the patient's medical record, the coding requirements of each health insurer, and best coding practices. Coding information provided under this heading does not provide a guarantee of reimbursement and should be considered together with all applicable coding guidance and standards. All of the coding information presented by this website is applicable to outpatient procedures only.
†CPT codes and descriptions only are ©2025 by American Medical Association (AMA). All rights reserved. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association.
‡This is a category code and is invalid for stand-alone use. Please select one of the expanded codes listed below.
References:
- Centers for Medicare & Medicaid Services. Discarded Drugs and Biologicals – JW Modifier and JZ Modifier Policy. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/JW-Modifier-FAQs.pdf. Accessed January 27, 2026.
- Centers for Medicare & Medicaid Services. 2026 ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/files/zip/2026-code-tables-tabular-and-index.zip. Accessed January 27, 2026.
- National Uniform Billing Committee (NUBC). Official UB-04 Data Specifications Manual 2020. Chicago, IL: American Hospital Association; 2020.
- American Medical Association. CPT 2025 Professional Edition. American Medical Association; 2024.
- OPDIVO® [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- Centers for Medicare & Medicaid Services. 2026 ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/files/zip/2026-code-tables-tabular-and-index.zip. Accessed January 27, 2026.
OPDIVO may be purchased through the distributors listed below.
Physician Offices
| Authorized Distributor | Phone & Fax Orders |
| Besse Medical > | Phone: 1-888‑711‑5469
|
| Cardinal Health Specialty Pharmaceutical Distribution > | Phone: 1-877‑453‑3972
|
| CuraScript Specialty Distribution > | Phone: 1‑877‑599‑7748
|
| HyGen Pharmaceuticals Specialty Division > | Phone: 1‑877‑630‑9198
|
| McKesson Specialty Health > | Phone: 1‑800‑482‑6700
|
| Morris & Dickson Specialty > | Phone: 1‑800‑710‑6100
Fax: 1‑318‑524‑3096
|
| Oncology Supply > | Phone: 1‑800‑633‑7555
|
For offices that prefer to use the services of a specialty pharmacy, specialty pharmacies can obtain OPDIVO from the distributors listed above.
Hospitals and Infusion Centers
| Authorized Distributor | Phone & Fax Orders |
| ASD Healthcare > | Phone: 1‑800‑746‑6273
Fax: 1‑800‑547‑9413
|
| Cardinal Health Specialty Pharmaceutical Distribution > | Phone: 1‑866‑677‑4844
Fax: 1‑614‑553‑6301
|
| DMS Pharmaceutical Group, Inc. > | Phone: 1‑877‑788‑1100
Fax: 1‑847‑518‑1105
|
| HyGen Pharmaceuticals Specialty Division > | Phone: 1‑877‑630‑9198
|
| McKesson Plasma and Biologics > | Phone: 1‑877‑625‑2566
Fax: 1‑888‑752‑7626
|
| Morris & Dickson Specialty > | Phone: 1‑800‑710‑6100
Fax: 1‑318‑524‑3096
|
Puerto Rico Hospitals and Clinics
| Authorized Distributor | Phone & Fax Orders |
| AmerisourceBergen Puerto Rico > | Phone: 1‑844‑222‑2273
|
Above information is accurate as of 01/26.
The OPDIVO distribution program includes extended payment terms to Bristol Myers Squibb authorized OPDIVO distributors. Healthcare providers and institutions should contact their OPDIVO distributor to understand specific payment terms that may be available to them from their distributor.
Please see U.S. Full Prescribing Information for OPDIVO.
FDA Approval Letters as Posted by the FDA:
Adjuvant Treatment of Melanoma
OPDIVO is indicated for the adjuvant treatment of adult and pediatric patients 12 years and older with completely resected Stage IIB, Stage IIC, Stage III, or Stage IV melanoma – Approved on 10/13/2023
Unresectable or Metastatic Melanoma
OPDIVO, as a single agent or in combination with ipilimumab, is indicated for the treatment of adult and pediatric patients 12 years of age and older with unresectable or metastatic melanoma – Approved on 03/07/2019
Neoadjuvant Treatment of Resectable NSCLC
OPDIVO, in combination with platinum-doublet chemotherapy, is indicated as neoadjuvant treatment of adult patients with resectable (tumors ≥4 cm or node positive) NSCLC – Approved on 03/04/2022
Neoadjuvant and Adjuvant Treatment of Resectable NSCLC
OPDIVO, in combination with platinum-doublet chemotherapy, is indicated for the neoadjuvant treatment of adult patients with resectable (tumors ≥4 cm or node positive) NSCLC and no known epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangements, followed by single-agent OPDIVO as adjuvant treatment after surgery – Approved on 10/03/2024
1L mNSCLC (PD-L1 ≥1%)
OPDIVO, in combination with ipilimumab, is indicated for the first-line treatment of adult patients with metastatic NSCLC 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
1L Metastatic or Recurrent NSCLC
OPDIVO, in combination with ipilimumab and 2 cycles of platinum-doublet chemotherapy, is indicated for the first-line treatment of adult patients with metastatic or recurrent NSCLC, with no EGFR or ALK genomic tumor aberrations – Approved on 05/26/2020
2L mNSCLC
OPDIVO is indicated for the treatment of adult patients with metastatic NSCLC with progression on or after platinum-based chemotherapy. Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving OPDIVO – Approved on 10/09/2015
1L Unresectable Malignant Pleural Mesothelioma
OPDIVO, in combination with ipilimumab, is indicated for the first-line treatment of adult patients with unresectable malignant pleural mesothelioma (MPM) – Approved on 10/02/2020
1L Intermediate or Poor Risk Advanced RCC
OPDIVO, in combination with ipilimumab, is indicated for the first-line treatment of adult patients with intermediate or poor risk advanced renal cell carcinoma (RCC) – Approved on 04/16/2018
1L Advanced RCC
OPDIVO, in combination with cabozantinib, is indicated for the first-line treatment of adult patients with advanced renal cell carcinoma (RCC) – Approved on 01/22/2021
2L Advanced RCC
OPDIVO, as a single agent, is indicated for the treatment of adult patients with advanced renal cell carcinoma (RCC) who have received prior anti-angiogenic therapy – Approved on 11/23/2015
2L Relapsed/Progressed Classical Hodgkin Lymphoma
OPDIVO, as a single agent, is indicated 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 03/20/2026
Previously Untreated Stage III or IV Classical Hodgkin Lymphoma
OPDIVO, in combination with doxorubicin, vinblastine, and dacarbazine (AVD), is indicated for the treatment of adult and pediatric patients 12 years and older with previously untreated, Stage III or IV classical Hodgkin lymphoma (cHL) – Approved on 03/20/2026
2L Squamous Cell Carcinoma of the Head and Neck
OPDIVO is indicated for the treatment of adult patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN) with disease progression on or after platinum-based therapy – Approved on 11/10/2016
Adjuvant Treatment of UC
OPDIVO is indicated for the adjuvant treatment of adult patients with urothelial carcinoma (UC) who are at high risk of recurrence after undergoing radical resection of UC – Approved on 08/20/2021
1L Unresectable or Metastatic UC
OPDIVO, in combination with cisplatin and gemcitabine, is indicated as first-line treatment for adult patients with unresectable or metastatic urothelial carcinoma – Approved on 03/06/2024
2L Locally Advanced/Metastatic UC
OPDIVO is indicated for the treatment of adult patients with locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy – Approved on 02/02/2017
1L MSI-H/dMMR Metastatic CRC
OPDIVO, in combination with ipilimumab, is indicated for the treatment of adult and pediatric patients 12 years and older with unresectable or metastatic microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) colorectal cancer (CRC) – Approved on 04/08/2025
2L MSI-H/dMMR Metastatic CRC
OPDIVO, as a single agent, is indicated for the treatment of adult and pediatric patients 12 years and older with microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) metastatic colorectal cancer (CRC) that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan – Approved on 07/31/2017
1L Unresectable or Metastatic HCC
OPDIVO, in combination with ipilimumab, is indicated for the first-line treatment of adult patients with unresectable or metastatic hepatocellular carcinoma (HCC) – Approved on 03/10/2020
2L Unresectable or Metastatic HCC
OPDIVO, in combination with ipilimumab, is indicated for the treatment of adult patients with unresectable or metastatic HCC who have been previously treated with sorafenib – Approved on 04/11/2025
1L Metastatic Gastric Cancer, Gastroesophageal Junction Cancer, and Esophageal Adenocarcinoma
OPDIVO, in combination with fluoropyrimidine- and platinum-containing chemotherapy, is indicated for the treatment of adult patients with advanced or metastatic gastric cancer, gastroesophageal junction cancer, and esophageal adenocarcinoma whose tumors express PD-L1 (≥1) – Approved on 05/23/2025
Adjuvant Treatment of Completely Resected Esophageal Cancer or Gastroesophageal Junction Cancer
OPDIVO is indicated for the adjuvant treatment of completely resected esophageal or gastroesophageal junction cancer with residual pathologic disease in adult patients who have received neoadjuvant chemoradiotherapy (CRT) – Approved on 05/20/2021
1L Unresectable Advanced or Metastatic Esophageal Squamous Cell Carcinoma
OPDIVO, in combination with fluoropyrimidine- and platinum-containing chemotherapy, is indicated for the first-line treatment of adult patients with unresectable advanced or metastatic esophageal squamous cell carcinoma (ESCC) whose tumors express PD-L1 (≥1) – Approved on 05/23/2025
OPDIVO, in combination with ipilimumab, is indicated for the first-line treatment of adult patients with unresectable advanced or metastatic esophageal squamous cell carcinoma (ESCC) whose tumors express PD-L1 (≥1) – Approved on 05/23/2025
2L Unresectable Advanced, Recurrent, or Metastatic Esophageal Squamous Cell Carcinoma
OPDIVO is indicated for the treatment of adult patients with unresectable advanced, recurrent, or metastatic esophageal squamous cell carcinoma (ESCC) after prior fluoropyrimidine- and platinum-based chemotherapy – Approved on 06/10/2020
Please see U.S. Full Prescribing Information for OPDIVO.
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Hospital Outpatient
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