HCPCS code J0897 — Denosumab injection.
Status: Active.
Effective Jan 1, 2012.
Source: CMS HCPCS Level II.
J0897
ActiveDenosumab injection
Injection, denosumab, 1 mg
Category:
Drugs
Section:
J-codes: Drugs Administered Other Than Oral Method
Effective:
Jan 1, 2012
Code type:
alphanumeric
OPPS Status:
K
— Non-pass-through drugs and biologicals
OPPS APC:
9272
Drug class:
RANKL Inhibitors
Medicare Part B utilization — 2023
Services billed
1,080,000
Beneficiaries
480,000
Medicare paid
$51,840,000
Avg per service
$60.00
Source: Medicare Part B Provider Utilization Public Use File (anonymized, aggregated to HCPCS level).
MUE — Medically Unlikely Edits
Maximum units of J0897 Medicare will pay for one beneficiary on one date of service. Claims exceeding the MUE are denied or returned for review.
| Service Type | Max Units / Day |
|---|---|
| DME Supplier | 0 |
| Outpatient Hospital | 120 |
| Practitioner Services | 120 |
Source: CMS Medicare NCCI Medically Unlikely Edits
NDC Crosswalk
National Drug Codes (NDCs) mapped to this HCPCS code.
| NDC | Drug Name |
|---|---|
| 55513-0710-01 | Prolia |
| 55513-0710-21 | Prolia |
| 55513-0730-01 | Xgeva |