Codes and coverage

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.

Read more about our coverage support offerings
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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.

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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
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SPRYCEL®

(dasatinib)

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.

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Reimbursement and Coding Guide
for SPRYCEL

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National Drug Codes (NDC)1

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.

00003-0527-11 Copy 20 mg tablet, 60 tablets per bottle
00003-0528-11 Copy 50 mg tablet, 60 tablets per bottle
00003-0524-11 Copy 70 mg tablet, 60 tablets per bottle
00003-0855-22 Copy 80 mg tablet, 30 tablets per bottle
00003-0852-22 Copy 100 mg tablet, 30 tablets per bottle
00003-0857-22 Copy 140 mg tablet, 30 tablets per bottle

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)2

Adult and Pediatric Chronic Myeloid Leukemia
C92 Myeloid leukemia
C92.1 Chronic myeloid leukemia (CML), BCR/ABL-positive†
C92.10 CML, BCR/ABL-positive, not having achieved remission
C92.11 CML, BCR/ABL-positive, in remission
C92.12 CML, BCR/ABL-positive, in relapse
Adult Acute Lymphoblastic Leukemia
C91 Lymphoid leukemia
C91.0 Acute lymphoblastic leukemia (ALL)†
C91.00 ALL, not having achieved remission
C91.01 ALL, in remission
C91.02 ALL, in relapse
Pediatric Acute Lymphoblastic Leukemia
C91 Lymphoid leukemia
C91.0 Acute lymphoblastic leukemia (ALL)†
C91.00 ALL, not having achieved remission
C91.01 ALL, in remission

*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.

†This is a category code and is invalid for stand-alone use.

References:

  1. SPRYCEL [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  2. 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 3, 2023.