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    HCPCS Details

    HCPC J0897
    Short Description Denosumab injection
    Long Description Injection, denosumab, 1 mg
    Pricing indicator 51
    Coverage code C
    ASC payment group code YY
    BETOS2 code O1E
    Action code N
    Type of service 1
    Effective date 2012-01-01
    Date Added 2012-01-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    55513071001 J0897 Denosumab injection Prolia AMGEN USA, INC. 1 MG 1 1 60 60
    55513073001 J0897 Denosumab injection XGEVA AMGEN USA, INC. 1 MG 1 1 120 120
    The ASP crosswalks are maintained by the Division of Data Analysis and Market Based Pricing to support ASP-based Medicare Part B payments only. The crosswalks are intended to help the public (including entities that submit manufacturer ASP data and providers who bill for drugs) understand which drug products (identified by NDCs) are assigned to which HCPCS billing codes. The crosswalks are not intended to be a comprehensive list of all drugs/NDCs available in the United States. The NDC to HCPCS Crosswalk also includes information on the NDC package size and the number of billable units (as defined by the HCPCS code descriptor). Comments on the file may be sent to [email protected].

    HCPCS Billing Calculator

    Dosage given to patient (per dose)
    HCPCS Dosage 1 MG
    HCPCS/CPT Billing Units 1
    Total doses ordered
    Billing Units 1

    Drug Details

    • Denosumab injection (Prolia) is used

      • to treat osteoporosis (a condition in which the bones become thin and weak and break easily) in women who have undergone menopause (''change of life;'' end of menstrual periods) who have an increased risk for fractures (broken bones) or who cannot take or did not respond to other medication treatments for osteoporosis.

      • to treat men who have an increased risk for fractures (broken bones) or who cannot take or did not respond to other medication treatments for osteoporosis.

      • treat osteoporosis that is caused by corticosteroid medications in men and women who will be taking corticosteroid medications for at least 6 months and have an increased risk for fractures or who cannot take or did not respond to other medication treatments for osteoporosis.

      • to treat bone loss in men who are being treated for prostate cancer with certain medications that cause bone loss,

      • to treat bone loss in women with breast cancer who are receiving certain medications that increase their risk for fractures.

    • Denosumab injection (Xgeva) is used

      • to reduce the risk of fractures in people who have multiple myeloma (cancer that begins in the plasma cells and causes bone damage), and in people who have certain types of cancer that began in another part of the body but has spread to the bones.

      • in adults and some adolescents to treat giant cell tumor of bone (GCTB; a type of bone tumor) that cannot be treated with surgery.

      • to treat high calcium levels that are caused by cancer in people who did not respond to other medications.

      Denosumab injection is in a class of medications called RANK ligand inhibitors. It works to prevent bone loss by blocking a certain receptor in the body to decrease bone breakdown. It works to treat GCTB by blocking a certain receptor in the tumor cells which slows the tumor growth. It works to treat high calcium levels by decreasing bone breakdown as the breakdown of bones releases calcium.