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.
REBLOZYL®
(luspatercept-aamt)
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.
Billing and Coding Tool
Have questions about the REBLOZYL billing and coding process? Our interactive tool can help provide coding and reimbursement information needed to complete the CMS-1500 and CMS-1450 forms.
Explore codes on this page: ⬇HCPCS ⬇Revenue Codes ⬇CPT ⬇ICD-10
Healthcare Common Procedure Coding System (HCPCS) Codes1
Issued by CMS
| J0896 | Injection, luspatercept-aamt, 0.25 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 Hospital Use)3
| 0636 | Drugs requiring detailed coding |
| 0250 | Pharmacy (General) |
| 0331 | Chemotherapy administration, injected |
Current Procedural Terminology (CPT)4†
| 96372 | Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular |
| 96401 | Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic |
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.
| 59572-0711-01 | 25 mg lyophilized powder in a single-dose vial for reconstitution |
| 59572-0775-01 | 75 mg lyophilized powder in a single-dose vial for reconstitution |
International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)6
| Beta Thalassemia | |
| D56.1 |
|
| D56.5 | Hemoglobin E-beta thalassemia |
| Myelodysplastic Syndromes | |
| D46.0 | Refractory anemia without ring sideroblasts, so stated |
| D46.1 | Refractory anemia with ring sideroblasts |
| D46.A | Refractory cytopenia with multilineage dysplasia |
| D46.B | Refractory cytopenia with multilineage dysplasia and ring sideroblasts |
| D46.4 | Refractory anemia, unspecified |
| D46.Z | Other myelodysplastic syndromes |
| D46.9 | Myelodysplastic syndrome, unspecified |
Coding for REBLOZYL is dependent on the insurer and the care setting in which the drug will be administered. Healthcare providers 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 REBLOZYL.
*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 guidance 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:
- Centers for Medicare & Medicaid Services. Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS) Application Summaries and Coding Decisions: First Quarter, 2020 Coding Cycle for Drug and Biological Products. https://www.cms.gov/files/document/2020-hcpcs-application-summary-quarter-1-2020-drugs-and-biologicals-updated-04142020.pdf. Accessed September 30, 2024.
- Medicare Claims Processing Manual. Chapter 17 – Drugs and Biologicals Revision 11572, August 25, 2022. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c17.pdf. Accessed September 30, 2024.
- National Uniform Billing Committee (NUBC). Official UB-04 Data Specifications Manual 2020. American Hospital Association; 2019. Accessed September 30, 2024.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- REBLOZYL [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 September 30, 2024.
REBLOZYL may be purchased through the distributors listed below.
Physician Offices
| Authorized Distributor | Phone & Fax Orders |
| Cardinal Health Specialty Pharmaceutical Distribution > | Phone: 1‑877‑453‑3972 |
| CuraScript Specialty Distribution > | Phone: 1‑877‑599‑7748 |
| 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 REBLOZYL 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 |
| 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 |
| Cardinal Puerto Rico (Borschow) > | Phone: 1‑787‑625‑4200 |
| Cesar Castillo, Inc. > | Phone: 1‑787‑641‑5242 (Hospitals) Phone: 1‑787‑641‑5082 (Specialty Pharmacies) Fax: 1‑787‑999‑1614 |
Above information is accurate as of 01/26.
The REBLOZYL distribution program includes extended payment terms to Bristol Myers Squibb authorized REBLOZYL distributors. Healthcare providers and institutions should contact their REBLOZYL distributor to understand specific payment terms that may be available to them from their distributor.
Please see U.S. Full Prescribing Information for REBLOZYL.
FDA Approval Letters as Posted by the FDA:
For the treatment of anemia in adult patients with beta thalassemia who require regular red blood cell (RBC) transfusions
For the treatment of anemia failing an erythropoiesis stimulating agent and requiring 2 or more red blood cell units over 8 weeks in adult patients with very low- to intermediate-risk myelodysplastic syndromes with ring sideroblasts (MDS-RS) or with myelodysplastic/myeloproliferative neoplasm with ring sideroblasts and thrombocytosis (MDS/MPN-RS-T).
For the treatment of anemia without previous erythropoiesis stimulating agent use (ESA-naïve) in adult patients with very low- to intermediate-risk myelodysplastic syndromes (MDS) who may require regular red blood cell (RBC) transfusions
Please see U.S. Full Prescribing Information for REBLOZYL.
Claim Forms for Outpatient Administration
Blank CMS-1500
Physician Office
Blank UB-04/CMS-1450
Hospital Outpatient
See Payer Policy Details
Learn about payer information by state for applicable treatments.
