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.
OPDUALAG®
(nivolumab and relatlimab-rmbw)
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.
Explore codes on this page: ⬇HCPCS ⬇Revenue Codes ⬇CPT ⬇NDC ⬇ICD-10
Healthcare Common Procedure Coding System (HCPCS) Codes1
Issued by CMS
| J9298 | Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg |
Revenue Codes (for Use in the Hospital Outpatient Setting)2
| 0636 | Drugs requiring detailed coding |
| 0335 | Chemotherapy administration, IV |
| 0260 | IV Therapy-General |
Current Procedural Terminology (CPT)3,†
| 96413 | 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 | 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.
References:
- 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. https://www.cms.gov/files/document/2022-hcpcs-application-summary-quarter-2-2022-drugs-and-biologicals-updated-07192022.pdf. Accessed August 2, 2023.
- Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed August 2, 2023.
- American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
- OPDUALAG [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/2023-icd-10-cm. Accessed August 2, 2023.
OPDUALAG 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 OPDUALAG from the distributors listed above.
Hospitals and Infusion Centers
| Specialty 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 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:
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
Please see U.S. Full Prescribing Information for OPDUALAG.
Claim Forms for Outpatient Administration
Sample CMS-1500
Physician Office
Sample UB-04/CMS-1450
Hospital Outpatient
Sample Medical Necessity Template Letter* Office Support Tool
*Template letters are provided as examples of potential correspondence.
See Payer Policy Details
Learn about payer information by state for applicable treatments.
