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
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.
National Drug Codes (NDC)1
Issued by the FDA
| 59572-0402-28 | 2.5 mg bottles of 28 capsules |
| 59572-0402-00 | 2.5 mg bottles of 100 capsules |
| 59572-0405-28 | 5 mg bottles of 28 capsules |
| 59572-0405-00 | 5 mg bottles of 100 capsules |
| 59572-0410-28 | 10 mg bottles of 28 capsules |
| 59572-0410-00 | 10 mg bottles of 100 capsules |
| 59572-0415-21 | 15 mg bottles of 21 capsules |
| 59572-0415-00 | 15 mg bottles of 100 capsules |
| 59572-0420-21 | 20 mg bottles of 21 capsules |
| 59572-0420-00 | 20 mg bottles of 100 capsules |
| 59572-0425-21 | 25 mg bottles of 21 capsules |
| 59572-0425-00 | 25 mg bottles of 100 capsules |
International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)2
| C90 | Multiple myeloma and malignant plasma cell neoplasms |
| C90.0 | Multiple myeloma |
| C90.00 | Multiple myeloma not having achieved remission |
| C90.01 | Multiple myeloma in remission |
| C90.02 | Multiple myeloma in relapse |
| D46 | Myelodysplastic syndromes |
| D46.0 | Refractory anemia without ring sideroblasts, so stated |
| D46.1 | Refractory anemia with ring sideroblasts |
| D46.2 | Refractory anemia with excess of blasts [RAEB] |
| D46.20 | Refractory anemia with excess of blasts, unspecified |
| D46.21 | Refractory anemia with excess of blasts 1 |
| D46.22 | Refractory anemia with excess of blasts 2 |
| D46.A | Refractory cytopenia with multilineage dysplasia |
| D46.B | Refractory cytopenia with multilineage dysplasia and ring sideroblasts |
| D46.C | Myelodysplastic syndromes with isolated del(5q) chromosomal abnormality |
| D46.4 | Refractory anemia, unspecified |
| D46.9 | Myelodysplastic syndromes, unspecified |
| C83.1 | Mantle cell lymphoma |
| C83.10 | Mantle cell lymphoma, unspecified site |
| C83.11 | Mantle cell lymphoma, lymph nodes of head, face, and neck |
| C83.12 | Mantle cell lymphoma, intrathoracic lymph nodes |
| C83.13 | Mantle cell lymphoma, intra-abdominal lymph nodes |
| C83.14 | Mantle cell lymphoma, lymph nodes of axilla and upper limb |
| C83.15 | Mantle cell lymphoma, lymph nodes of inguinal region and lower limb |
| C83.16 | Mantle cell lymphoma, intrapelvic lymph nodes |
| C83.17 | Mantle cell lymphoma, spleen |
| C83.18 | Mantle cell lymphoma, lymph nodes of multiple sites |
| C83.19 | Mantle cell lymphoma, extranodal and solid organ sites |
| C82.0 | Follicular lymphoma grade I |
| C82.00 | Follicular lymphoma grade I, unspecified site |
| C82.01 | Follicular lymphoma grade I, lymph nodes of head, face, and neck |
| C82.02 | Follicular lymphoma grade I, intrathoracic lymph nodes |
| C82.03 | Follicular lymphoma grade I, intra-abdominal lymph nodes |
| C82.04 | Follicular lymphoma grade I, lymph nodes of axilla and upper limb |
| C82.05 | Follicular lymphoma grade I, lymph nodes of inguinal region and lower limb |
| C82.06 | Follicular lymphoma grade I, intrapelvic lymph nodes |
| C82.07 | Follicular lymphoma grade I, spleen |
| C82.08 | Follicular lymphoma grade I, lymph nodes of multiple sites |
| C82.09 | Follicular lymphoma grade I, extranodal and solid organ sites |
| C82.1 | Follicular lymphoma grade II |
| C82.10 | Follicular lymphoma grade II, unspecified site |
| C82.11 | Follicular lymphoma grade II, lymph nodes of head, face, and neck |
| C82.12 | Follicular lymphoma grade II, intrathoracic lymph nodes |
| C82.13 | Follicular lymphoma grade II, intra-abdominal lymph nodes |
| C82.14 | Follicular lymphoma grade II, lymph nodes of axilla and upper limb |
| C82.15 | Follicular lymphoma grade II, lymph nodes of inguinal region and lower limb |
| C82.16 | Follicular lymphoma grade II, intrapelvic lymph nodes |
| C82.17 | Follicular lymphoma grade II, spleen |
| C82.18 | Follicular lymphoma grade II, lymph nodes of multiple sites |
| C82.19 | Follicular lymphoma grade II, extranodal and solid organ sites |
| C82.2 | Follicular lymphoma grade III, unspecified |
| C82.20 | Follicular lymphoma grade III, unspecified, unspecified site |
| C82.21 | Follicular lymphoma grade III, unspecified, lymph nodes of head, face, and neck |
| C82.22 | Follicular lymphoma grade III, unspecified, intrathoracic lymph nodes |
| C82.23 | Follicular lymphoma grade III, unspecified, intra-abdominal lymph nodes |
| C82.24 | Follicular lymphoma grade III, unspecified, lymph nodes of axilla and upper limb |
| C82.25 | Follicular lymphoma grade III, unspecified, lymph nodes of inguinal region and lower limb |
| C82.26 | Follicular lymphoma grade III, unspecified, intrapelvic lymph nodes |
| C82.27 | Follicular lymphoma grade III, unspecified, spleen |
| C82.28 | Follicular lymphoma grade III, unspecified, lymph nodes of multiple sites |
| C82.29 | Follicular lymphoma grade III, unspecified, extranodal and solid organ sites |
| C82.3 | Follicular lymphoma grade IIIA |
| C82.30 | Follicular lymphoma grade IIIA, unspecified site |
| C82.31 | Follicular lymphoma grade IIIA, lymph nodes of head, face, and neck |
| C82.32 | Follicular lymphoma grade IIIA, intrathoracic lymph nodes |
| C82.33 | Follicular lymphoma grade IIIA, intra-abdominal lymph nodes |
| C82.34 | Follicular lymphoma grade IIIA, lymph nodes of axilla and upper limb |
| C82.35 | Follicular lymphoma grade IIIA, lymph nodes of inguinal region and lower limb |
| C82.36 | Follicular lymphoma grade IIIA, intrapelvic lymph nodes |
| C82.37 | Follicular lymphoma grade IIIA, spleen |
| C82.38 | Follicular lymphoma grade IIIA, lymph nodes of multiple sites |
| C82.39 | Follicular lymphoma grade IIIA, extranodal and solid organ sites |
| C82.8 | Other types of follicular lymphoma |
| C82.80 | Other types of follicular lymphoma, unspecified site |
| C82.81 | Other types of follicular lymphoma, lymph nodes of head, face, and neck |
| C82.82 | Other types of follicular lymphoma, intrathoracic lymph nodes |
| C82.83 | Other types of follicular lymphoma, intra-abdominal lymph nodes |
| C82.84 | Other types of follicular lymphoma, lymph nodes of axilla and upper limb |
| C82.85 | Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb |
| C82.86 | Other types of follicular lymphoma, intrapelvic lymph nodes |
| C82.87 | Other types of follicular lymphoma, spleen |
| C82.88 | Other types of follicular lymphoma, lymph nodes of multiple sites |
| C82.89 | Other types of follicular lymphoma, extranodal and solid organ site |
| C82.9 | Follicular lymphoma, unspecified |
| C82.90 | Follicular lymphoma, unspecified, unspecified site |
| C82.91 | Follicular lymphoma, unspecified, lymph nodes of head, face, and neck |
| C82.92 | Follicular lymphoma, unspecified, intrathoracic lymph nodes |
| C82.93 | Follicular lymphoma, unspecified, intra-abdominal lymph nodes |
| C82.94 | Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb |
| C82.95 | Follicular lymphoma, unspecified, lymph nodes of inguinal region and lower limb |
| C82.96 | Follicular lymphoma, unspecified, intrapelvic lymph nodes |
| C82.97 | Follicular lymphoma, unspecified, spleen |
| C82.98 | Follicular lymphoma, unspecified, lymph nodes of multiple sites |
| C82.99 | Follicular lymphoma, unspecified, extranodal and solid organ sites |
| C88.4 | Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT-lymphoma) |
Coding for REVLIMID 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 REVLIMID, including Boxed WARNINGS.
*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.
References:
- REVLIMID [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/ICD10/2023-ICD-10-CM. Accessed July 5, 2023.
Prescribers and pharmacies must be certified with the Lenalidomide REMS program by enrolling and complying with the REMS requirements; pharmacies must only dispense to patients who are authorized to receive REVLIMID. The REMS-Pharmacy Network list includes specialty pharmacies that are contracted to fill prescriptions for restricted distribution programs for Bristol Myers Squibb.
Specialty Pharmacies
| Pharmacy | Phone & Fax Orders |
| Absolute Pharmacy | Phone: 1-787-892-8700
Fax: 1-787-496-1010
|
| AcariaHealth Pharmacy | Phone: 1-866-458-9246
Fax: 1-866-458-9245
|
| Accredo Specialty Pharmacy | Phone: 1-877-732-3431
Fax: 1-800-590-1021
|
| ACS Advanced Care Scripts | Phone: 1-877-985-6337
Fax: 1-866-679-7131
|
| AllianceRx Walgreens Prime | Phone: 1-888-347-3416
Fax: 1-877-231-8302
|
| Amber Specialty Pharmacy | Phone: 1-888-370-1724
Fax: 1-877-645-7514
|
| Axium Healthcare Puerto Rico | Phone: 1-787-780-7200
Fax: 1-800-546-2163
|
| Biologics by McKesson | Phone: 1-800-850-4306
Fax: 1-800-823-4506
|
| Biomatrix | Phone: 1-888-662-6779
Fax: 1-877-800-4790
|
| BioPlus Specialty Pharmacy | Phone: 1-888-292-0744
Fax: 1-800-269-5493
|
| CareMed Specialty Pharmacy | Phone: 1-877-227-3405
Fax: 1-877-542-2731
|
| CVS Specialty | Phone: 1-800-237-2767
Fax: 1-800-323-2445
|
| Farmacia San Rafael | Phone: 1-787-724-3333
Fax: 1-787-721-4165
|
| Humana Specialty Pharmacy | Phone: 1-800-486-2668
Fax: 1-877-405-7940
|
| Kroger Specialty Pharmacy | Phone: 1-888-327-2962
Fax: 1-888-315-3270
|
| Magellan Rx Pharmacy (ICORE) | Phone: 1-866-554-2673
Fax: 1-866-364-2673
|
| Onco360 | Phone: 1-877-662-6633
Fax: 1-877-662-6355
|
| Optum Specialty Pharmacy | Phone: 1-877-445-6874
Fax: 1-866-306-5231
|
| RxCrossroads by McKesson (VA Dispensing) | Phone: 1-855-637-9433
Fax: 1-855-637-9446
|
| Special Care Pharmacy Services | Phone: 1-787-783-8579
Fax: 1-787-783-2951
|
| Upstate Pharmacy | Phone: 1-800-314-4655
Fax: 1-800-314-7756
|
| US Bioservices | Phone: 1-877-757-0667
Fax: 1-888-899-0067
|
Above information is accurate as of 01/26.
The REVLIMID distribution program includes extended payment terms to Bristol Myers Squibb authorized REVLIMID distributors. Healthcare providers and institutions should contact their REVLIMID distributor to understand specific payment terms that may be available to them from their distributor.
Please see U.S. Full Prescribing Information for REVLIMID, including Boxed WARNINGS.
FDA Approval Letters as Posted by the FDA:
For the treatment of adult patients with multiple myeloma in combination with dexamethasone who have received at least one prior therapy
For the treatment of adult patients with multiple myeloma in combination with dexamethasone
For the treatment of adult patients with multiple myeloma as maintenance therapy following autologous hematopoietic stem cell transplant
For the treatment of adult patients with transfusion dependent anemia due to low or intermediate-1 risk myelodysplastic syndromes associated with a deletion 5q cytogenetic abnormality with or without additional cytogenetic abnormalities
For the treatment of adult patients with mantle cell lymphoma whose disease has relapsed or progressed after two prior therapies, one of which included bortezomib
For the treatment of adult patients with previously treated follicular lymphoma in combination with a rituximab product
For the treatment of adult patients with previously treated marginal zone lymphoma in combination with a rituximab product
Please see U.S. Full Prescribing Information for REVLIMID, including Boxed WARNINGS.
See Payer Policy Details
Learn about payer information by state for applicable treatments.
