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Q5157

Q5157 – Inj, denosumab-bmwo, 1 mg · NDC Crosswalk & Billing Units

HCPCS Level II Q-code · Medicare Part B drug billing
Q-code ● 2 NDCs crosswalked per 1 MG $25.979/unit ASP+6%

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Compiled from public FDA, CMS, DailyMed, NADAC, and related drug data sources. Editorial policy

📋 Q5157 summary

Q5157 is a HCPCS Level II Q-code used to bill denosumab-bmwo, 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 Q5157: Osenvelt*, Stoboclo, Osenvelt

Code Q5157 Billing unit 1 MG Payment limit $25.979/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 codeQ5157
DescriptorInj, denosumab-bmwo, 1 mg
Billing unit1 MG
Payment limit / unit$25.979
Est. ASP / unit$24.508 est.
Mapped NDCs2
Data periodQ3 2026
Last updated2026-08-20

🧾 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
$25.979
Est. ASP / unit
$24.508 est.
Est. after 2% sequester
$25.459
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 Q5157 = 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 Q5157 LEAST EXPENSIVE FIRST

2 NDCs map to Q5157. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($25.979/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
72606-0037-01 Stoboclo denosumab-bmwo 60 mg/mL INJECTION CELLTRION 1 SYRINGE in 1 CARTON (72606-037-01) / 1... 60 mg/mL 60 $1,558.74 $1,584.710 ● Active CMS ASP
72606-0038-01 Osenvelt denosumab-bmwo 120 mg/1.7mL INJECTION CELLTRION 1 VIAL, SINGLE-USE in 1 CARTON (72606-038-... 120 mg/1.7mL 120 $3,117.48 — ● 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
$45.19M
Claims
19,782
Beneficiaries
17,501
Spend / beneficiary
$2,582.08
Spend / claim
$2,284.34
Trend by period
Where Q5157 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #71 of 824
#66 TEPEZZA J3241 $50.56M #67 UPLIZNA J1823 $49M #68 COSENTYX J3247 $48.68M #69 ASCENIV J1554 $48.54M #70 ADCETRIS J9042 $46.69M #71 OSENVELT* Q5157 $45.19M #72 ERBITUX J9055 $44.95M #73 ELIGARD* J9217 $43.65M #74 VYALEV J7356 $43.08M #75 ABRAXANE* J9264 $42.14M #76 COMIRNATY * 91320 $42.06M
Total claims — #110 of 824
#105 NEULASTA ONPRO* J2506 20,607 #106 MONOVISC J7327 20,428 #107 ZILRETTA J3304 20,149 #108 UDENYCA AUTOINJECTOR... Q5111 19,977 #109 HYMOVIS ONE* J7322 19,847 #110 OSENVELT* Q5157 19,782 #111 MIDAZOLAM HCL J2250 19,674 #112 RITUXAN J9312 19,253 #113 AZACITIDINE* J9025 19,241 #114 EMEND* J1453 19,071 #115 ALBUKED-25(P9047)* P9047 18,777

Full breakdown by period (2)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2026 (Q1) $45.19M 17,501 19,782 $2,582.08 $2,284.34
2025 (Q1-Q4) $13.72M 4,891 5,535 $2,805.35 $2,478.94
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
$11.85M
Medicare paid
$9.27M
Submitted services
434,954
Denial rate
11.9%
Allowed / service
$30.93
Submitted charges
$29.86M
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.

❓ Q5157 billing FAQ

What is HCPCS code Q5157?
Q5157 is a HCPCS Level II Q-code used to bill Inj, denosumab-bmwo, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for Q5157?
One unit of Q5157 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of Q5157 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 Q5157?
The Medicare Part B payment limit is $25.979 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $25.459 per unit. Payment limits are revised quarterly.
Which NDCs bill under Q5157?
2 NDCs currently map to Q5157 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 Q5157 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.