OPDIVO J Code: J9299

Drug & Product Overview

HCPCS Descriptor Injection, nivolumab, 1 mg

HCPCS Added Date January 1, 2016

Manufacturer BMS

Route of Administration Intravenous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Injection

About OPDIVO

Opdivo is a medication aligned to the HCPCS J Code: J9299 for billing, pricing, and reimbursement purposes in the United States. It is administered via the intravenous route and manufactured by BMS.

According to CMS Drug Use Information: Nivolumab is used to treat cancer. It works by helping your immune system fight the cancer. Nivolumab belongs to a class of drugs known as monoclonal antibodies.

Disclaimer: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your healthcare professional.

NDC Code Information

Based on publicly available CMS files. The list of NDCs below is not exhaustive.

NDC Code	Drug	Manufacturer	Billing Units / Pkg	Package Size
00003-3734-13	Opdivo	E.R. Squibb & Sons, L.L.C.	240	240 MG / 24 ML
00003-3756-14	Opdivo	E.R. Squibb & Sons, L.L.C.	120	120 MG / 12 ML
00003-3772-11	Opdivo	E.R. Squibb & Sons, L.L.C.	40	40 MG / 4 ML
00003-3774-12	Opdivo	E.R. Squibb & Sons, L.L.C.	100	100 MG / 10 ML

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OPDIVO Pricing & Reimbursement

J9299 Private Payer Reimbursement

$34.54 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

Create an account on PayerPrice for more information →

Historical Graphing and Billing Calculator

per HCPCS unit

As of Q3 2026

OPDIVO Claims Performance

Claims from Jan 2026 – Aug 2026

Claim Denial Rate 10.23%

Avg. Days to File 8.4days

Avg. Days to Pay 25.2days

Real-world claims performance from FocalPoint, OnPoint Oncology's reimbursement analytics platform, with claims data accrued at the clearing house level.

Explore J9299 claims analytics on FocalPoint →

OPDIVO CPT Administration Codes

CPT Code	Description
96413	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96415	Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)

JW / JZ modifiers apply

CMS has identified Opdivo (J9299) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

OPDIVO Medically Unlikely Edits (MUE)

The most billing units of J9299 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 mg.

Practitioner Office & Hospital Outpatient

480 units / day

= 480 mg per day

MAI 3 · Date of Service Edit: Clinical. Per-day limit based on clinical expectations; excess units are denied but may be appealed with documentation of medical necessity. See all MUE limits →

OPDIVO Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.

Advanced renal cell carcinoma Classical Hodgkin lymphoma Esophageal or gastroesophageal junction cancer Esophageal squamous cell carcinoma Gastric cancer, gastroesophageal junction cancer, and esophageal adenocarcinoma Hepatocellular carcinoma Locally advanced or metastatic urothelial carcinoma MSI-H or dMMR colorectal cancer MSI-H or dMMR metastatic colorectal cancer Malignant pleural mesothelioma Melanoma Metastatic non-small cell lung cancer Metastatic or recurrent non-small cell lung cancer Resectable non-small cell lung cancer Squamous cell carcinoma of the head and neck Unresectable or metastatic melanoma Unresectable or metastatic urothelial carcinoma Urothelial carcinoma

Show all 18 conditions Show fewer

Drug Class

Programmed Death Receptor-1 Blocking Antibody [EPC]Programmed Death Receptor-1-directed Antibody Interactions [MoA]

Frequently Asked Questions

Is there an available Opdivo billing and coding guide?

Billing and coding information for OPDIVO can be found through Bristol Myers Squibb. Visit Here →

Are there any available Opdivo patient assistance programs?

OPDIVO patient assistance information can be found through Bristol Myers Squibb. Visit Here →

Where can I find Opdivo prescribing information?

OPDIVO prescribing information can be found at the link below: Visit Here →

Where can I find Opdivo side effect information?

Information regarding OPDIVO's side effects can be found at MedlinePlus Visit Here →

Does billing OPDIVO require JZ/JW wastage modifiers?

CMS has identified OPDIVO(J9299) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. See CMS guidelines on use of the JZ and JW wastage modifiers below.

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