Yervoy (ipilimumab) — HCPCS J9228

CareCost Estimate · Billing Cheat Sheet
Bristol Myers Squibb 50 mg/10 mL & 200 mg/40 mL single-dose vials (5 mg/mL) IV infusion (30 min mono / 90 min combo) Reviewed: May 2, 2026 ASP: Q2 2026
HCPCS
J9228
1 unit = 1 mg (NOT 10 mg!)
Dose
1 or 3 mg/kg
Regimen-dependent — verify FIRST
Modifier
JZ / JW
JW common (waste from weight-based)
Admin CPT
96413
+ 96417 if combo with Opdivo
Medicare ASP+6%
$187.166
/mg · ~$44,920 per 240 mg dose
TOP BILLER ERROR: J9228 = 1 mg per unit, NOT 10 mg. A 240 mg dose = 240 units (not 24). Despite Yervoy's 5 mg/mL concentrate format, the HCPCS descriptor is "Injection, ipilimumab, 1 mg." Reconfigure billing software before any J9228 claim.

Codes & NDC

HCPCSJ9228 — "Inj, ipilimumab, 1 mg" (permanent, eff. 1/1/2013)
NDC 50 mg00003-2327-11 (50 mg / 10 mL SDV)
NDC 200 mg00003-2328-22 (200 mg / 40 mL SDV)
Concentrate5 mg/mL — dilute in 0.9% NaCl or 5% Dextrose
Sister codeJ9299 Opdivo (nivolumab) — combo partner on most regimens

Regimen table (dose ratio is critical!)

IndicationIpi dose+ Opdivo
Melanoma adj or 1L mono3 mg/kg q3w × 4—
Melanoma 1L combo3 mg/kg q3w × 41 mg/kg
RCC 1L combo1 mg/kg q3w × 43 mg/kg
MSI-H/dMMR CRC1 mg/kg q3w × 43 mg/kg
HCC + Opdivo3 mg/kg q3w × 41 mg/kg
NSCLC + chemo1 mg/kg q6w360 mg q3w
Mesothelioma1 mg/kg q6w360 mg q3w
Esophageal SCC3 mg/kg q3w3 mg/kg q2w
Pediatric melanoma adj (≥12)3 mg/kg q3w × 4—
Memorize: RCC + CRC = "low ipi" (1 mg/kg). All others combo = "high ipi" (3 mg/kg). Reversing doses is a top denial driver AND a safety risk.

Administration coding

CodeWhen
96413Chemo IV up to 1 hr — first/only drug (always for Yervoy)
96417Each addl sequential infusion up to 1 hr — second drug in combo
96415Each addl hr (rarely needed; for 90-min combo runs)
96365NOT appropriate — Yervoy is chemo admin per AMA
Combo with Opdivo (same day): 96413 ONCE (first drug) + 96417 ONCE (second drug). Do NOT bill 96413 twice. Yervoy typically infused first.

Modifiers

  • JW — partial-vial waste (common, weight-based dosing). Bill discarded mg on separate line. At ~$187/mg, every unbilled mg is real money.
  • JZ — required when no waste (rarer with Yervoy)
  • One of JZ or JW must be on every J9228 claim (CMS 7/1/2023 SDV policy)
  • Modifier 25 — same-day E/M only when distinct from infusion-day routine
  • 340B (JG, TB) — per MAC policy

ICD-10 by indication

CodeFor
C43.xMelanoma (adj + advanced; adult + ped ≥12)
C64.xRCC intermed/poor risk (+ Opdivo)
C18.x / C19 / C20CRC + MSI-H/dMMR biomarker (+ Opdivo)
C22.0HCC (+ Opdivo, 2L+ post-sorafenib)
C34.xNSCLC 1L PD-L1+ (+ Opdivo + chemo)
C45.0Mesothelioma (+ Opdivo)
C15.xEsophageal SCC (+ Opdivo)

Biomarker testing (separate lines)

TestCPTFor
MMR IHC ×488342CRC (required)
MSI by PCR81301CRC (alt to MMR)
PD-L1 IHC (22C3)88360/88361NSCLC 1L combo
HER2 IHC/FISH88342/88377Esophageal (optional)
FoundationOne CDx0244UMulti-biomarker
Get biomarker results BEFORE submitting Yervoy + Opdivo PA. CRC combo without MSI-H/dMMR = guaranteed denial.

Payer requirements (May 2026)

PayerPANotes
UnitedHealthcareYesConcurrent PA on Yervoy + Opdivo; Optum-managed site-of-care
AetnaYesCPB 0892 — combo PA; biomarker enforcement strict
BCBS plansYesVary; aligned with NCCN + FDA label biomarkers
Single combo PA covers BOTH drugs. Do not submit separately for ipi and nivo.

Medicare reimbursement (Q2 2026)

FieldValue
ASP + 6%$187.166 / mg (eff. 4/1 – 6/30/2026)
240 mg dose (3 mg/kg, 80 kg)$44,919.84
80 mg dose (1 mg/kg, 80 kg)$14,973.28
4-dose induction (3 mg/kg, 80 kg)~$179,679
4-dose induction (1 mg/kg, 80 kg)~$59,893

By far most expensive checkpoint inhibitor per mg — ~5-6× Opdivo's $33.624/mg.

Patient assistance — BMS Access Support

  • Phone: 1-800-861-0048 (BMS Access Support — covers Yervoy + Opdivo together)
  • Commercial copay: $0 copay, up to ~$25,000/yr (excludes Medicare/Medicaid/federal)
  • BMS PAP: free drug for uninsured/underinsured
  • Foundations: PAN, HealthWell, CancerCare (verify open oncology funds quarterly)
  • Web: bmsaccesssupport.com/yervoy
HIGHEST irAE RATE OF ANY CHECKPOINT INHIBITOR. No formal Boxed Warning, but treat W&P as one. Severe/fatal: colitis (with bowel perforation), hypophysitis (Yervoy is leading drug-induced cause), pneumonitis, hepatitis, T1DM/DKA, adrenal insufficiency, SJS/TEN, encephalitis. Combo with Opdivo: grade 3-4 irAE rates can exceed 50%. Monitor LFTs, TSH, AM cortisol, glucose before EVERY dose. Have colitis/pneumonitis management plan ready.
Sources: BMS Access Support 2026, FDA label (Mar 2026, BLA 125377), CMS ASP Q2 2026, UHC/Aetna ICI policies (CPB 0892), NCCN Guidelines (Melanoma/RCC/CRC/HCC/NSCLC), AAPC. carecostestimate.com/drugs/yervoy