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
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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.

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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
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The accurate completion of reimbursement- or coverage-related documentation is the responsibility of the healthcare provider and patient. Bristol Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.

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Reimbursement and Coding Guide

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Healthcare Common Procedure Coding System (HCPCS) Codes1

Issued by CMS

J9298 Copy Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg

Revenue Codes (for Use in the Hospital Outpatient Setting)2

0636 Copy Drugs requiring detailed coding
0335 Copy Chemotherapy administration, IV
0260 Copy IV Therapy-General

Current Procedural Terminology (CPT)3,†

96413 Copy Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug

National Drug Codes (NDC)4

Issued by the FDA

Note: Payers require the submission of the 11-digit NDC on healthcare claim forms. Please use the 11-digit codes shown here.

00003-7125-11 Copy A single-dose vial containing 240 mg of nivolumab and 80 mg of relatlimab per 20 mL (12 mg and 4 mg per mL) per carton

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)5

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
C43.62 Malignant melanoma of left upper limb, including shoulder
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

Note: 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.

Coding for OPDUALAG 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 OPDUALAG.

*Healthcare providers should code healthcare claims based upon the service that is rendered, the patient’s medical record, the coding requirements of each health insurer, and best coding practices. Coding information provided under this heading does not provide a guarantee of reimbursement and should be considered together with all applicable coding guidance and standards. All of the coding information presented by this website is applicable to outpatient procedures only.

CPT codes and descriptions only are ©2023 by American Medical Association (AMA). All rights reserved. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association.

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


  1. Centers for Medicare & Medicaid Services. Centers for Medicare and Medicaid Services (CMS) Healthcare Common Procedure Coding Systems (HCPCS) Application Summaries and Coding Recommendations: Second Quarter, 2022 HCPCS Coding Cycle. Accessed August 2, 2023.
  2. Palmetto GBA. Medicare Part A Billing Guide. May 2017.$File/Part_A_Billing_Guide.pdf. Accessed August 2, 2023.
  3. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  4. OPDUALAG [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  5. Centers for Medicare & Medicaid Services. ICD-10-CM tabular list of diseases and injuries. Accessed August 2, 2023.

OPDUALAG may be purchased through the distributors listed below.

Physician Offices

Authorized Distributor Phone Orders Fax Orders and Website
Cardinal Health Specialty Pharmaceutical Distribution 1‑877‑453‑3972
CuraScript Specialty Distribution 1‑877‑599‑7748
McKesson Specialty Health 1‑800‑482‑6700
Morris & Dickson Specialty 1‑800‑710‑6100 Fax: 1‑318‑524‑3096
Oncology Supply 1‑800‑633‑7555

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

Hospitals and Infusion Centers

Specialty Distributor Phone Orders Fax Orders and Website
ASD Healthcare 1‑800‑746‑6273 Fax: 1‑800‑547‑9413
Cardinal Health Specialty Pharmaceutical Distribution 1‑866‑677‑4844 Fax: 1‑614‑553‑6301
DMS Pharmaceutical Group, Inc. 1‑877‑788‑1100 Fax: 1‑847‑518‑1105
McKesson Plasma and Biologics 1‑877‑625‑2566 Fax: 1‑888‑752‑7626
Morris & Dickson Specialty 1‑800‑710‑6100 Fax: 1‑318‑524‑3096

Puerto Rico Hospitals and Clinics

Authorized Distributor Phone Orders Fax Orders and Website
Bergen Puerto Rico
Cardinal Puerto Rico (Borschow) 1‑787‑625‑4200
Cesar Castillo, Inc. 1‑787‑641‑5242 (Hospitals)
1‑787‑641‑5082 (Specialty Pharmacies)
Fax: 1‑787‑999‑1614

Above information is accurate as of 12/23.

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

Please see U.S. Full Prescribing Information for OPDUALAG.

FDA Approval Letter as Posted by the FDA:

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OPDUALAG is indicated for the treatment of adult and pediatric patients 12 years of age or older with unresectable or metastatic melanoma – Approved on 03/18/2022

View Letter

Please see U.S. Full Prescribing Information for OPDUALAG.

Claim Forms for Outpatient Administration – Tutorial

Physician Office
Hospital Outpatient
Office Support Tool
Medical Necessity Template Letter*

*Template letters are provided as examples of potential correspondence.

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