This information is intended for U.S. healthcare professionals and/or
healthcare professionals involved in healthcare reimbursement.
This site is intended for U.S. residents 18 years of age or older.
Live Support
1-800-861-0048
8 AM to 8 PM ET, Mon–Fri
We’d love your feedback on your experience today.
Please take this quick survey to help us continue to provide you with information
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
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.
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
Medication Menu
OPDIVO Qvantig™
(nivolumab and hyaluronidase-nvhy)
Indication(s) Important Safety Information U.S. Full Prescribing 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.
Reimbursement and Coding Guide
for OPDIVO QVANTIG
Select Your Patient’s Condition
Filter results by:
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 unused drugs and biologicals that are appropriately discarded. Also, providers and suppliers must document the amount of discarded drugs or biologicals in Medicare beneficiaries’ medical records.2
Providers and suppliers are required to report the JZ modifier to attest if there were no discarded amounts of drugs and biologicals.3
Depending on payer preferences for billing and coding, the required miscellaneous J-code and billing unit conversion for claim submission may vary. Therefore, the provider should confirm preference with the payer prior to submitting. Please contact the payer or BMS Access Support® for additional information on coding and billing units.
Revenue Codes (for Hospital Use)4
Current Procedural Terminology (CPT)5,†
Coding for OPDIVO QVANTIG 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 QVANTIG.
*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 ©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:
- American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
- 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 September 12, 2024.
- Centers for Medicare & Medicaid Services. Calendar year (CY) 2023 Medicare physician fee schedule final rule. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule. Accessed September 12, 2024.
- National Uniform Billing Committee (NUBC). Official UB-04 Data Specifications Manual 2020. Chicago, IL: American Hospital Association; 2020. Accessed September 12, 2024.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDIVO QVANTIG [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 12, 2024.
Select Your Patient’s Condition
OPDIVO QVANTIG may be purchased through the distributors listed below.
Physician Offices
| Authorized Distributor | Phone Orders | Fax Orders and Website |
|---|---|---|
| Besse Medical | 1‑877‑711‑5469 | https://www.besse.com |
| Cardinal Health Specialty Pharmaceutical Distribution | 1‑877‑453‑3972 Monday-Friday (24-hour emergency on call) |
https://specialtyonline.cardinalhealth.com |
| CuraScript Specialty Distribution | 1‑877‑599‑7748 Monday-Friday |
https://www.curascriptsd.com |
| HyGen Pharmaceuticals Specialty Division | 1‑877‑630‑9198 Monday-Friday |
https://www.hygenpharma.com/#contactus |
| McKesson Specialty Health | 1‑800‑482‑6700 Monday-Friday |
https://mscs.mckesson.com |
| Morris & Dickson Specialty | 1‑800‑710‑6100 Monday-Friday |
Fax: 1‑318‑524‑3096 https://www.mdspecialtydist.com |
| Oncology Supply | 1‑800‑633‑7555 | https://www.oncologysupply.com |
For offices that prefer to use the services of a specialty pharmacy, specialty pharmacies can obtain OPDIVO QVANTIG from the distributors listed above.
Hospitals and Infusion Centers
| Authorized Distributor | Phone Orders | Fax Orders and Website |
|---|---|---|
| ASD Healthcare | 1‑800‑746‑6273 Monday-Friday |
Fax: 1‑800‑547‑9413 https://www.asdhealthcare.com |
| Cardinal Health Specialty Pharmaceutical Distribution | 1‑866‑677‑4844 Monday-Friday (24-hour emergency on call) |
Fax: 1‑614‑553‑6301 https://orderexpress.cardinalhealth.com |
| DMS Pharmaceutical Group, Inc. | 1‑877‑788‑1100 | Fax: 1‑847‑518‑1105 www.dmspharma.com |
| HyGen Pharmaceuticals Specialty Division | 1‑877‑630‑9198 Monday-Friday |
https://www.hygenpharma.com/#contactus |
| McKesson Plasma and Biologics | 1‑877‑625‑2566 Monday-Friday |
Fax: 1‑888‑752‑7626 https://connect.mckesson.com |
| Morris & Dickson Specialty | 1‑800‑710‑6100 Monday-Friday |
Fax: 1‑318‑524‑3096 https://www.mdspecialtydist.com |
Puerto Rico Hospitals and Clinics
| Authorized Distributor | Phone Orders | Fax Orders and Website |
|---|---|---|
| Amerisource Bergen Puerto Rico |
1‑844‑222‑2273 | https://abcorder.amerisourcebergen.com |
Above information is accurate as of 11/24.
The OPDIVO QVANTIG distribution program includes extended payment terms to Bristol Myers Squibb authorized OPDIVO QVANTIG distributors. Healthcare providers and institutions should contact their OPDIVO QVANTIG distributor to understand specific payment terms that may be available to them from their distributor.
Please see U.S. Full Prescribing Information for OPDIVO QVANTIG.
Select Your Patient’s Condition
FDA Approval Letter as Posted by the FDA:
Please see U.S. Full Prescribing Information for OPDIVO QVANTIG for complete indications.
Claim Forms for Outpatient Administration – Tutorial
Physician Office
CMS-1500
Hospital Outpatient
UB-04/CMS-1450See Payer Policy Details
See Payer Policy Details
Learn about payer information by state for applicable treatments.
