Q5158
Q5158 – Inj, denosumab-bnht, 1 mg · NDC Crosswalk & Billing Units
HCPCS Level II Q-code · Medicare Part B drug billing
Q-code
● 3 NDCs crosswalked per 1 MG $28.818/unit ASP+6%
📋 Q5158 summary
Q5158 is a HCPCS Level II Q-code used to bill denosumab-bnht, 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 Q5158: Bomyntra*, Conexxence, Bomyntra
Code Q5158
Billing unit 1 MG Payment limit $28.818/unit NDC-Crosswalk 3
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 codeQ5158
DescriptorInj, denosumab-bnht, 1 mg
Billing unit1 MG
Payment limit / unit$28.818
Est. ASP / unit$27.187 est.
Mapped NDCs3
Data periodQ3 2026
Last updated2026-09-20
🧾 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
$28.818
Est. ASP / unit
$27.187 est.
Est. after 2% sequester
$28.242
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 Q5158 = 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 Q5158 LEAST EXPENSIVE FIRST
3 NDCs map to Q5158. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($28.818/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 65219-0668-01 | CONEXXENCE Denosumab 60 mg/mL INJECTION | Fresenius | 1 SYRINGE, PLASTIC in 1 CARTON (65219-668-... | 60 mg/mL | 60 | $1,729.08 | $1,740.450 | ● Active | CMS ASP |
| 65219-0670-01 | BOMYNTRA Denosumab 70 mg/mL INJECTION | Fresenius | 1 VIAL, SINGLE-DOSE in 1 CARTON (65219-670... | 70 mg/mL | 120 | $3,458.16 | — | ● Active | CMS ASP |
| 65219-0672-01 | BOMYNTRA Denosumab 70 mg/mL INJECTION | Fresenius | 1 SYRINGE, PLASTIC in 1 CARTON (65219-672-... | 70 mg/mL | 120 | $3,458.16 | — | ● 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
$14.42M
Claims
6,821
Beneficiaries
6,145
Spend / beneficiary
$2,347.13
Spend / claim
$2,114.52
Trend by period
Where Q5158 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #150 of 824
#145
DESCOVY J0751
$15.17M
#146
FULPHILA Q5108
$15.02M
#147
FLUAD * 90653
$15.02M
#148
EXPAREL J0666
$15.01M
#149
ZUSDURI J9282
$14.54M
#150
BOMYNTRA* Q5158
$14.42M
#151
IMJUDO J9347
$14.18M
#152
HERCEPTIN J9355
$13.84M
#153
LEVULAN J7308
$13.55M
#154
MEMBRANE GRAFT OR WR... Q4205
$13.47M
#155
RENFLEXIS Q5104
$12.69M
Total claims — #195 of 824
#190
NIVESTYM Q5110
6,956
#191
OGIVRI Q5114
6,950
#192
VYVGART HYTRULO J9334
6,883
#193
OZURDEX J7312
6,823
#194
ROLVEDON J1449
6,822
#195
BOMYNTRA* Q5158
6,821
#196
ENGERIX-B ADULT(9074... 90747
6,808
#197
ATROPINE SULFATE(J04... J0462
6,802
#198
FIRMAGON J9155
6,761
#199
VYEPTI J3032
6,673
#200
THIAMINE HCL J3411
6,638
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) | $14.42M | 6,145 | 6,821 | $2,347.13 | $2,114.52 |
| 2025 (Q1-Q4) | $4.05M | 1,545 | 1,756 | $2,618.25 | $2,303.64 |
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
$2.56M
Medicare paid
$2.01M
Submitted services
91,560
Denial rate
3.5%
Allowed / service
$28.97
Submitted charges
$5.85M
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.
🗺️ Where Q5158 is utilized
⏳
The geographic utilization map is building for this code — it aggregates millions of CMS Part B claim lines, then caches the result. Refresh in a moment; if it doesn’t appear, this code may have no reportable Part B utilization.
🗃️ 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 2026-09-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk
3 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.
❓ Q5158 billing FAQ
What is HCPCS code Q5158?
Q5158 is a HCPCS Level II Q-code used to bill Inj, denosumab-bnht, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for Q5158?
One unit of Q5158 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of Q5158 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 Q5158?
The Medicare Part B payment limit is $28.818 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $28.242 per unit. Payment limits are revised quarterly.
Which NDCs bill under Q5158?
3 NDCs currently map to Q5158 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 Q5158 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.