Q5136
Q5136 – Inj. denosumab-bbdz, 1 mg · NDC Crosswalk & Billing Units
HCPCS Level II Q-code · Medicare Part B drug billing
Q-code
● 2 NDCs crosswalked per 1 MG $27.665/unit ASP+6%
📋 Q5136 summary
Q5136 is a HCPCS Level II Q-code used to bill denosumab-bbdz, 1 mg, billed per 1 MG. The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.
Brand names associated with Q5136: Jubbonti*, Wyost, Jubbonti
Code Q5136
Billing unit 1 MG Payment limit $27.665/unit NDC-Crosswalk 2
Quarter Q3 2026
RxCUI Atlas Trace the drug concept →
⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.
🗂️ Key billing facts
HCPCS codeQ5136
DescriptorInj. denosumab-bbdz, 1 mg
Billing unit1 MG
Payment limit / unit$27.665
Est. ASP / unit$26.099 est.
Mapped NDCs2
Data periodQ3 2026
Last updated2026-08-20
💊 About Denosumab Injection DRUG GUIDE
Jubbonti (denosumab) injection is used to treat osteoporosis in postmenopausal women and men at high risk for fracture, including those who have already had a fracture or who have not responded to other osteoporosis medicines.
It is also used to treat osteoporosis caused by long-term steroid (glucocorticoid) use in men and women.Jubbonti is additionally used to increase bone mass in men receiving androgen deprivation therapy (a hormone-lowering treatment) for nonmetastatic prostate cancer, and in women receiving aromatase inhibitor therapy for breast cancer — both of which can weaken bones over time.
Clinical overview from our editorial drug guide for Denosumab Injection. For billing reference, see the sections above.
🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026
📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$27.665
Est. ASP / unit
$26.099 est.
Est. after 2% sequester
$27.112
HCPCS dosage
1 MG
The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly), Q3 2026.
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of Q5136 = 1 mg. Enter a regimen to convert dose → billing units and project a full course.
Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.
🔁 NDCs that bill under Q5136 LEAST EXPENSIVE FIRST
2 NDCs map to Q5136. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($27.665/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 61314-0240-63 | JUBBONTI denosumab 60 mg/mL INJECTION | Sandoz | 1 SYRINGE in 1 CARTON (61314-240-63) / 1... | 60 mg/mL | 60 | $1,659.90 | $1,537.250 | ● Active | CMS ASP |
| 61314-0228-94 | WYOST denosumab 120 mg/1.7mL INJECTION | Sandoz | 1 VIAL, SINGLE-DOSE in 1 CARTON (61314-228... | 120 mg/1.7mL | 120 | $3,319.80 | — | ● Active | CMS ASP |
NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.
📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)
Period
Total Part B spend
$70.44M
Claims
34,987
Beneficiaries
32,032
Spend / beneficiary
$2,198.96
Spend / claim
$2,013.23
Trend by period
Where Q5136 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #49 of 824
#44
TEZSPIRE J2356
$75.17M
#45
NUCALA J2182
$74.59M
#46
CARVYKTI Q2056
$74.24M
#47
LANREOTIDE ACETATE(J... J1930
$73.87M
#48
OHTUVAYRE J7601
$71.49M
#49
JUBBONTI* Q5136
$70.44M
#50
JEMPERLI J9272
$70.43M
#51
POLIVY J9309
$67.74M
#52
PERJETA J9306
$67.3M
#53
TRODELVY J9317
$66.92M
#54
PREVNAR 20 90677
$66.9M
Total claims — #72 of 824
#67
OPDIVO J9299
37,629
#68
FLUOROURACIL J9190
37,237
#69
ORTHOVISC J7324
37,232
#70
YUPELRI J7677
37,078
#71
ACTEMRA(J3262) J3262
36,246
#72
JUBBONTI* Q5136
34,987
#73
ENVARSUS XR J7503
34,358
#74
RECLAST* J3489
34,241
#75
RETACRIT(Q5106) Q5106
33,752
#76
LEVULAN J7308
31,923
#77
FERAHEME(Q0138)* Q0138
31,621
Top Medicare Part B drugs by the selected metric. Click any drug to open its J-code page. Source: CMS Medicare Quarterly Part B Spending by Drug.
Full breakdown by period (2)
| Period | Total spend | Beneficiaries | Claims | $/beneficiary | $/claim |
|---|---|---|---|---|---|
| 2026 (Q1) | $70.44M | 32,032 | 34,987 | $2,198.96 | $2,013.23 |
| 2025 (Q1-Q4) | $61.77M | 26,076 | 29,775 | $2,368.83 | $2,074.55 |
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.
📈 Medicare Part B claims detail CMS PSPS · 2024
Calendar-year 2024 Medicare Part B fee-for-service activity for this HCPCS code, summed across all carriers, localities and specialties (CMS Physician/Supplier Procedure Summary). A “service” is one billed line/unit — not one claim — so counts run higher than claim counts.
Allowed charges
$36.16M
Medicare paid
$28.29M
Submitted services
1,265,165
Denial rate
5.1%
Allowed / service
$30.12
Submitted charges
$94.98M
Source: CMS Physician/Supplier Procedure Summary (PSPS), CY2024 — Medicare Part B carrier + DME fee-for-service claims (excludes Medicare Advantage). Figures are for the whole HCPCS code, which may cover uses beyond this drug. ⚠ CMS hides any figure covering fewer than 11 patients (a privacy rule), so totals — especially denials and low-volume codes — run a little low.
🗃️ Data sources & freshness
Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.
HCPCS code & descriptor
CMS HCPCS Level II code file
Not available in current dataset
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Q3 2026 · as of 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk
2 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
Available for mapped NDCs
Utilization & spend
CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners
Latest data year 2026
Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.
⚠️ Practical billing caveats
- A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
- Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
- Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
- Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
- The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
- Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.
❓ Q5136 billing FAQ
What is HCPCS code Q5136?
Q5136 is a HCPCS Level II Q-code used to bill Inj. denosumab-bbdz, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for Q5136?
One unit of Q5136 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of Q5136 should I bill?
Divide the dose administered by the code's unit size (1 MG) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for Q5136?
The Medicare Part B payment limit is $27.665 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $27.112 per unit. Payment limits are revised quarterly.
Which NDCs bill under Q5136?
2 NDCs currently map to Q5136 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.
Does a crosswalk mean Q5136 is covered?
No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.
For professional billing reference only — verify against the current CMS files before submitting claims.