Codes and Coverage

Explore codes on this page:      ⬇HCPCS      ⬇CPT      ⬇NDC      ⬇ICD-10

Healthcare Common Procedure Coding System (HCPCS) Codes¹

Issued by CMS

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

Current Procedural Terminology (CPT)^3,†

National Drug Codes (NDC)⁴

Issued by the FDA

Note: The NDCs for YERVOY, shown here, are often necessary in addition to the appropriate J- or C-code when filing a claim for reimbursement.

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

Coding for 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.

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

*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 ©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.

References:

1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
2. 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 August 2, 2023.
3. American Medical Association. Current Procedural Terminology 2019. Professional ed. Chicago, IL: American Medical Association; 2018.
4. YERVOY (ipilimumab) [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
5. 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 August 2, 2023.