Page reviewed Jun 29, 2026 · from CMS Article A52399 (CMS last revised 03/27/2026)
Quick answer
Medicare benefit
Part B (physician-administered)
Covered diagnoses
409 ICD-10 codes
Governing policy
A52399 / L33394
Contractor (MAC)
National Government Services, Inc.
CMS article revised
03/27/2026
Page reviewed
Jun 29, 2026
HCPCS codes covered:
J0897J3590Q5136Q5157Q5158Q5159
J0897J3590Q5136Q5157Q5158Q5159
Coverage varies by Medicare Administrative Contractor (MAC). This list is National Government Services, Inc.'s policy (Article A52399), which administers Part B in Illinois, Minnesota, Wisconsin, Connecticut, Maine, Massachusetts +4 more. In another state? Other MACs may publish a different covered list — find your MAC by state →
What Medicare pays for Denosumab (Prolia, Xgeva) (2026 Q2)
Once a claim carries a covered diagnosis, Medicare Part B reimburses the drug at the ASP + 6% payment limit. Current allowed amounts per billing unit:
| HCPCS | Description | Per unit | Allowed (ASP + 6%) |
|---|---|---|---|
| J0897 | Denosumab injection | 1 mg | $29.507 |
| Q5136 | Inj. denosumab-bbdz, 1 mg | 1 mg | $27.914 |
| Q5157 | Inj, denosumab-bmwo, 1 mg | 1 mg | $26.209 |
| Q5158 | Inj, denosumab-bnht, 1 mg | 1 mg | $29.797 |
Source: CMS ASP Drug Pricing File, 2026 Q2. Payment = ASP + 6% per unit; multiply by units billed (watch JZ/JW wastage). Your patient's share is typically 20% after the deductible. Estimate the full cost & patient out-of-pocket →
Denosumab (Prolia, Xgeva) is a physician-administered biologic billed under Medicare Part B (not the Part D pharmacy benefit). Under Part B, Medicare pays the practice for the drug (HCPCS J0897) plus its administration — but only when the claim's diagnosis (ICD-10) code supports medical necessity. Each MAC publishes the specific covered diagnoses in a Billing & Coding Article; a claim with a diagnosis outside that list is typically denied as not medically necessary (CO-50).
Covered ICD-10 diagnoses for Denosumab (Prolia, Xgeva)
The 409 codes below are the diagnoses National Government Services, Inc. accepts for J0897 under Article A52399, grouped exactly as CMS groups them and organized by condition category for scanning. Use the filter in each group to find a specific code or condition.
Group 1 — 161 covered diagnoses (applies to Q5159, J3590, Q5157, Q5158, J0897, Q5136)
Xgeva® Biosimilar Indications Effective 01/01/2026 Demosumab-dssb ( Xbryk ) should be reported using HCPCS code Q5159 01/01/2026, Denosumab-nxxp ( Bilprevda®) should be reported using HCPCS code J3590 Effective 10/1/2025, Demosumab-bmwo ( Osenvelt®) should be reported using HCPCS code Q5157 Effective 10/1/2025, Demosumab-bnht ( Bomyntra ) should be reported using HCPCS code Q5158 Effective 10/1/2025, Denosumab ( Xgeva®) should be reported using HCPCS J0897 Effective 10/1/2025, Denosumab-bbdz ( Wyost®) should be reported using HCPCS Q5136 For the treatment of patients with bone metastases from solid tumors. Note: multiple myeloma, lymphoma and other cancers of the blood are not considered solid tumors). Effective for dates of service on or after 01/04/2018, the FDA has approved denosumab (Xgeva®) for the treatment of skeletal-related events in patients with multiple myeloma. For the treatment of adults and skeletally mature adolescents with giant cell tumor of bone that is unresectable or where surgical resection is likely to result in severe morbidity. ICD-10-CM code E83.52 should be used to report management of hypercalcemia of malignancy .
Diseases of the musculoskeletal system & connective tissue (133)
| ICD-10 | Covered diagnosis |
|---|---|
| M84.511A | Pathological fracture in neoplastic disease, right shoulder, initial encounter for fracture |
| M84.511D | Pathological fracture in neoplastic disease, right shoulder, subsequent encounter for fracture with routine healing |
| M84.511G | Pathological fracture in neoplastic disease, right shoulder, subsequent encounter for fracture with delayed healing |
| M84.511K | Pathological fracture in neoplastic disease, right shoulder, subsequent encounter for fracture with nonunion |
| M84.511P | Pathological fracture in neoplastic disease, right shoulder, subsequent encounter for fracture with malunion |
| M84.511S | Pathological fracture in neoplastic disease, right shoulder, sequela |
| M84.512A | Pathological fracture in neoplastic disease, left shoulder, initial encounter for fracture |
| M84.512D | Pathological fracture in neoplastic disease, left shoulder, subsequent encounter for fracture with routine healing |
| M84.512G | Pathological fracture in neoplastic disease, left shoulder, subsequent encounter for fracture with delayed healing |
| M84.512K | Pathological fracture in neoplastic disease, left shoulder, subsequent encounter for fracture with nonunion |
| M84.512P | Pathological fracture in neoplastic disease, left shoulder, subsequent encounter for fracture with malunion |
| M84.512S | Pathological fracture in neoplastic disease, left shoulder, sequela |
| M84.521A | Pathological fracture in neoplastic disease, right humerus, initial encounter for fracture |
| M84.521D | Pathological fracture in neoplastic disease, right humerus, subsequent encounter for fracture with routine healing |
| M84.521G | Pathological fracture in neoplastic disease, right humerus, subsequent encounter for fracture with delayed healing |
| M84.521K | Pathological fracture in neoplastic disease, right humerus, subsequent encounter for fracture with nonunion |
| M84.521P | Pathological fracture in neoplastic disease, right humerus, subsequent encounter for fracture with malunion |
| M84.521S | Pathological fracture in neoplastic disease, right humerus, sequela |
| M84.522A | Pathological fracture in neoplastic disease, left humerus, initial encounter for fracture |
| M84.522D | Pathological fracture in neoplastic disease, left humerus, subsequent encounter for fracture with routine healing |
| M84.522G | Pathological fracture in neoplastic disease, left humerus, subsequent encounter for fracture with delayed healing |
| M84.522K | Pathological fracture in neoplastic disease, left humerus, subsequent encounter for fracture with nonunion |
| M84.522P | Pathological fracture in neoplastic disease, left humerus, subsequent encounter for fracture with malunion |
| M84.522S | Pathological fracture in neoplastic disease, left humerus, sequela |
| M84.531A | Pathological fracture in neoplastic disease, right ulna, initial encounter for fracture |
| M84.531D | Pathological fracture in neoplastic disease, right ulna, subsequent encounter for fracture with routine healing |
| M84.531G | Pathological fracture in neoplastic disease, right ulna, subsequent encounter for fracture with delayed healing |
| M84.531K | Pathological fracture in neoplastic disease, right ulna, subsequent encounter for fracture with nonunion |
| M84.531P | Pathological fracture in neoplastic disease, right ulna, subsequent encounter for fracture with malunion |
| M84.531S | Pathological fracture in neoplastic disease, right ulna, sequela |
| M84.532A | Pathological fracture in neoplastic disease, left ulna, initial encounter for fracture |
| M84.532D | Pathological fracture in neoplastic disease, left ulna, subsequent encounter for fracture with routine healing |
| M84.532G | Pathological fracture in neoplastic disease, left ulna, subsequent encounter for fracture with delayed healing |
| M84.532K | Pathological fracture in neoplastic disease, left ulna, subsequent encounter for fracture with nonunion |
| M84.532P | Pathological fracture in neoplastic disease, left ulna, subsequent encounter for fracture with malunion |
| M84.532S | Pathological fracture in neoplastic disease, left ulna, sequela |
| M84.533A | Pathological fracture in neoplastic disease, right radius, initial encounter for fracture |
| M84.533D | Pathological fracture in neoplastic disease, right radius, subsequent encounter for fracture with routine healing |
| M84.533G | Pathological fracture in neoplastic disease, right radius, subsequent encounter for fracture with delayed healing |
| M84.533K | Pathological fracture in neoplastic disease, right radius, subsequent encounter for fracture with nonunion |
| M84.533P | Pathological fracture in neoplastic disease, right radius, subsequent encounter for fracture with malunion |
| M84.533S | Pathological fracture in neoplastic disease, right radius, sequela |
| M84.534A | Pathological fracture in neoplastic disease, left radius, initial encounter for fracture |
| M84.534D | Pathological fracture in neoplastic disease, left radius, subsequent encounter for fracture with routine healing |
| M84.534G | Pathological fracture in neoplastic disease, left radius, subsequent encounter for fracture with delayed healing |
| M84.534K | Pathological fracture in neoplastic disease, left radius, subsequent encounter for fracture with nonunion |
| M84.534P | Pathological fracture in neoplastic disease, left radius, subsequent encounter for fracture with malunion |
| M84.534S | Pathological fracture in neoplastic disease, left radius, sequela |
| M84.541A | Pathological fracture in neoplastic disease, right hand, initial encounter for fracture |
| M84.541D | Pathological fracture in neoplastic disease, right hand, subsequent encounter for fracture with routine healing |
| M84.541G | Pathological fracture in neoplastic disease, right hand, subsequent encounter for fracture with delayed healing |
| M84.541K | Pathological fracture in neoplastic disease, right hand, subsequent encounter for fracture with nonunion |
| M84.541P | Pathological fracture in neoplastic disease, right hand, subsequent encounter for fracture with malunion |
| M84.541S | Pathological fracture in neoplastic disease, right hand, sequela |
| M84.542A | Pathological fracture in neoplastic disease, left hand, initial encounter for fracture |
| M84.542D | Pathological fracture in neoplastic disease, left hand, subsequent encounter for fracture with routine healing |
| M84.542G | Pathological fracture in neoplastic disease, left hand, subsequent encounter for fracture with delayed healing |
| M84.542K | Pathological fracture in neoplastic disease, left hand, subsequent encounter for fracture with nonunion |
| M84.542P | Pathological fracture in neoplastic disease, left hand, subsequent encounter for fracture with malunion |
| M84.542S | Pathological fracture in neoplastic disease, left hand, sequela |
| M84.550A | Pathological fracture in neoplastic disease, pelvis, initial encounter for fracture |
| M84.550D | Pathological fracture in neoplastic disease, pelvis, subsequent encounter for fracture with routine healing |
| M84.550G | Pathological fracture in neoplastic disease, pelvis, subsequent encounter for fracture with delayed healing |
| M84.550K | Pathological fracture in neoplastic disease, pelvis, subsequent encounter for fracture with nonunion |
| M84.550P | Pathological fracture in neoplastic disease, pelvis, subsequent encounter for fracture with malunion |
| M84.550S | Pathological fracture in neoplastic disease, pelvis, sequela |
| M84.551A | Pathological fracture in neoplastic disease, right femur, initial encounter for fracture |
| M84.551D | Pathological fracture in neoplastic disease, right femur, subsequent encounter for fracture with routine healing |
| M84.551G | Pathological fracture in neoplastic disease, right femur, subsequent encounter for fracture with delayed healing |
| M84.551K | Pathological fracture in neoplastic disease, right femur, subsequent encounter for fracture with nonunion |
| M84.551P | Pathological fracture in neoplastic disease, right femur, subsequent encounter for fracture with malunion |
| M84.551S | Pathological fracture in neoplastic disease, right femur, sequela |
| M84.552A | Pathological fracture in neoplastic disease, left femur, initial encounter for fracture |
| M84.552D | Pathological fracture in neoplastic disease, left femur, subsequent encounter for fracture with routine healing |
| M84.552G | Pathological fracture in neoplastic disease, left femur, subsequent encounter for fracture with delayed healing |
| M84.552K | Pathological fracture in neoplastic disease, left femur, subsequent encounter for fracture with nonunion |
| M84.552P | Pathological fracture in neoplastic disease, left femur, subsequent encounter for fracture with malunion |
| M84.552S | Pathological fracture in neoplastic disease, left femur, sequela |
| M84.561A | Pathological fracture in neoplastic disease, right tibia, initial encounter for fracture |
| M84.561D | Pathological fracture in neoplastic disease, right tibia, subsequent encounter for fracture with routine healing |
| M84.561G | Pathological fracture in neoplastic disease, right tibia, subsequent encounter for fracture with delayed healing |
| M84.561K | Pathological fracture in neoplastic disease, right tibia, subsequent encounter for fracture with nonunion |
| M84.561P | Pathological fracture in neoplastic disease, right tibia, subsequent encounter for fracture with malunion |
| M84.561S | Pathological fracture in neoplastic disease, right tibia, sequela |
| M84.562A | Pathological fracture in neoplastic disease, left tibia, initial encounter for fracture |
| M84.562D | Pathological fracture in neoplastic disease, left tibia, subsequent encounter for fracture with routine healing |
| M84.562G | Pathological fracture in neoplastic disease, left tibia, subsequent encounter for fracture with delayed healing |
| M84.562K | Pathological fracture in neoplastic disease, left tibia, subsequent encounter for fracture with nonunion |
| M84.562P | Pathological fracture in neoplastic disease, left tibia, subsequent encounter for fracture with malunion |
| M84.562S | Pathological fracture in neoplastic disease, left tibia, sequela |
| M84.563A | Pathological fracture in neoplastic disease, right fibula, initial encounter for fracture |
| M84.563D | Pathological fracture in neoplastic disease, right fibula, subsequent encounter for fracture with routine healing |
| M84.563G | Pathological fracture in neoplastic disease, right fibula, subsequent encounter for fracture with delayed healing |
| M84.563K | Pathological fracture in neoplastic disease, right fibula, subsequent encounter for fracture with nonunion |
| M84.563P | Pathological fracture in neoplastic disease, right fibula, subsequent encounter for fracture with malunion |
| M84.563S | Pathological fracture in neoplastic disease, right fibula, sequela |
| M84.564A | Pathological fracture in neoplastic disease, left fibula, initial encounter for fracture |
| M84.564D | Pathological fracture in neoplastic disease, left fibula, subsequent encounter for fracture with routine healing |
| M84.564G | Pathological fracture in neoplastic disease, left fibula, subsequent encounter for fracture with delayed healing |
| M84.564K | Pathological fracture in neoplastic disease, left fibula, subsequent encounter for fracture with nonunion |
| M84.564P | Pathological fracture in neoplastic disease, left fibula, subsequent encounter for fracture with malunion |
| M84.564S | Pathological fracture in neoplastic disease, left fibula, sequela |
| M84.569A | Pathological fracture in neoplastic disease, unspecified tibia and fibula, initial encounter for fracture |
| M84.571A | Pathological fracture in neoplastic disease, right ankle, initial encounter for fracture |
| M84.571D | Pathological fracture in neoplastic disease, right ankle, subsequent encounter for fracture with routine healing |
| M84.571G | Pathological fracture in neoplastic disease, right ankle, subsequent encounter for fracture with delayed healing |
| M84.571K | Pathological fracture in neoplastic disease, right ankle, subsequent encounter for fracture with nonunion |
| M84.571P | Pathological fracture in neoplastic disease, right ankle, subsequent encounter for fracture with malunion |
| M84.571S | Pathological fracture in neoplastic disease, right ankle, sequela |
| M84.572A | Pathological fracture in neoplastic disease, left ankle, initial encounter for fracture |
| M84.572D | Pathological fracture in neoplastic disease, left ankle, subsequent encounter for fracture with routine healing |
| M84.572G | Pathological fracture in neoplastic disease, left ankle, subsequent encounter for fracture with delayed healing |
| M84.572K | Pathological fracture in neoplastic disease, left ankle, subsequent encounter for fracture with nonunion |
| M84.572P | Pathological fracture in neoplastic disease, left ankle, subsequent encounter for fracture with malunion |
| M84.572S | Pathological fracture in neoplastic disease, left ankle, sequela |
| M84.574A | Pathological fracture in neoplastic disease, right foot, initial encounter for fracture |
| M84.574D | Pathological fracture in neoplastic disease, right foot, subsequent encounter for fracture with routine healing |
| M84.574G | Pathological fracture in neoplastic disease, right foot, subsequent encounter for fracture with delayed healing |
| M84.574K | Pathological fracture in neoplastic disease, right foot, subsequent encounter for fracture with nonunion |
| M84.574P | Pathological fracture in neoplastic disease, right foot, subsequent encounter for fracture with malunion |
| M84.574S | Pathological fracture in neoplastic disease, right foot, sequela |
| M84.575A | Pathological fracture in neoplastic disease, left foot, initial encounter for fracture |
| M84.575D | Pathological fracture in neoplastic disease, left foot, subsequent encounter for fracture with routine healing |
| M84.575G | Pathological fracture in neoplastic disease, left foot, subsequent encounter for fracture with delayed healing |
| M84.575K | Pathological fracture in neoplastic disease, left foot, subsequent encounter for fracture with nonunion |
| M84.575P | Pathological fracture in neoplastic disease, left foot, subsequent encounter for fracture with malunion |
| M84.575S | Pathological fracture in neoplastic disease, left foot, sequela |
| M84.58XA | Pathological fracture in neoplastic disease, other specified site, initial encounter for fracture |
| M84.58XD | Pathological fracture in neoplastic disease, other specified site, subsequent encounter for fracture with routine healing |
| M84.58XG | Pathological fracture in neoplastic disease, other specified site, subsequent encounter for fracture with delayed healing |
| M84.58XK | Pathological fracture in neoplastic disease, other specified site, subsequent encounter for fracture with nonunion |
| M84.58XP | Pathological fracture in neoplastic disease, other specified site, subsequent encounter for fracture with malunion |
| M84.58XS | Pathological fracture in neoplastic disease, other specified site, sequela |
Neoplasms (27)
| ICD-10 | Covered diagnosis |
|---|---|
| C40.01 | Malignant neoplasm of scapula and long bones of right upper limb |
| C40.02 | Malignant neoplasm of scapula and long bones of left upper limb |
| C40.11 | Malignant neoplasm of short bones of right upper limb |
| C40.12 | Malignant neoplasm of short bones of left upper limb |
| C40.21 | Malignant neoplasm of long bones of right lower limb |
| C40.22 | Malignant neoplasm of long bones of left lower limb |
| C40.31 | Malignant neoplasm of short bones of right lower limb |
| C40.32 | Malignant neoplasm of short bones of left lower limb |
| C40.81 | Malignant neoplasm of overlapping sites of bone and articular cartilage of right limb |
| C40.82 | Malignant neoplasm of overlapping sites of bone and articular cartilage of left limb |
| C40.91 | Malignant neoplasm of unspecified bones and articular cartilage of right limb |
| C40.92 | Malignant neoplasm of unspecified bones and articular cartilage of left limb |
| C41.9 | Malignant neoplasm of bone and articular cartilage, unspecified |
| C79.51 | Secondary malignant neoplasm of bone |
| C90.00 | Multiple myeloma not having achieved remission |
| C90.01 | Multiple myeloma in remission |
| C90.02 | Multiple myeloma in relapse |
| C90.10 | Plasma cell leukemia not having achieved remission |
| C90.11 | Plasma cell leukemia in remission |
| C90.12 | Plasma cell leukemia in relapse |
| C90.20 | Extramedullary plasmacytoma not having achieved remission |
| C90.21 | Extramedullary plasmacytoma in remission |
| C90.22 | Extramedullary plasmacytoma in relapse |
| C90.30 | Solitary plasmacytoma not having achieved remission |
| C90.31 | Solitary plasmacytoma in remission |
| C90.32 | Solitary plasmacytoma in relapse |
| D48.0 | Neoplasm of uncertain behavior of bone and articular cartilage |
Endocrine, nutritional & metabolic diseases (1)
| ICD-10 | Covered diagnosis |
|---|---|
| E83.52 | Hypercalcemia |
Group 2 — 248 covered diagnoses (applies to Q5158, J3590, Q5157, Q5159, J0897, Q5136)
Prolia® biosimilars indications Treatment of osteoporosis at high risk for fracture Effective 01/01/2026, Demosumab-bnht ( Conexxence ) should be reported using HCPCS code Q5158 Effective 01/01/2026, Denosumab-nxxp ( Bildyos® ) should be reported using HCPCS code J3590 Effective 10/1/2025, Demosumab-bmwo ( Stoboclo ) should be reported using HCPCS code Q5157 Effective 10/1/2025, Demosumab-dssb ( Ospomyv ) should be reported using HCPCS code Q5159 Effective 10/1/2025, Denosumab ( Prolia® ) should be reported using HCPCS J0897 Effective 10/1/2025, Denosumab-bbdz ( Jubbonti® ) should be reported using HCPCS Q5136
Diseases of the musculoskeletal system & connective tissue (206)
| ICD-10 | Covered diagnosis |
|---|---|
| M80.011A | Age-related osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture |
| M80.011D | Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with routine healing |
| M80.011G | Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing |
| M80.011K | Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with nonunion |
| M80.011P | Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with malunion |
| M80.011S | Age-related osteoporosis with current pathological fracture, right shoulder, sequela |
| M80.012A | Age-related osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture |
| M80.012D | Age-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with routine healing |
| M80.012G | Age-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with delayed healing |
| M80.012K | Age-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with nonunion |
| M80.012P | Age-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with malunion |
| M80.012S | Age-related osteoporosis with current pathological fracture, left shoulder, sequela |
| M80.021A | Age-related osteoporosis with current pathological fracture, right humerus, initial encounter for fracture |
| M80.021D | Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing |
| M80.021G | Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with delayed healing |
| M80.021K | Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with nonunion |
| M80.021P | Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with malunion |
| M80.021S | Age-related osteoporosis with current pathological fracture, right humerus, sequela |
| M80.022A | Age-related osteoporosis with current pathological fracture, left humerus, initial encounter for fracture |
| M80.022D | Age-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with routine healing |
| M80.022G | Age-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with delayed healing |
| M80.022K | Age-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with nonunion |
| M80.022P | Age-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with malunion |
| M80.022S | Age-related osteoporosis with current pathological fracture, left humerus, sequela |
| M80.031A | Age-related osteoporosis with current pathological fracture, right forearm, initial encounter for fracture |
| M80.031D | Age-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with routine healing |
| M80.031G | Age-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with delayed healing |
| M80.031K | Age-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with nonunion |
| M80.031P | Age-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with malunion |
| M80.031S | Age-related osteoporosis with current pathological fracture, right forearm, sequela |
| M80.032A | Age-related osteoporosis with current pathological fracture, left forearm, initial encounter for fracture |
| M80.032D | Age-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with routine healing |
| M80.032G | Age-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with delayed healing |
| M80.032K | Age-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with nonunion |
| M80.032P | Age-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with malunion |
| M80.032S | Age-related osteoporosis with current pathological fracture, left forearm, sequela |
| M80.041A | Age-related osteoporosis with current pathological fracture, right hand, initial encounter for fracture |
| M80.041D | Age-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with routine healing |
| M80.041G | Age-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with delayed healing |
| M80.041K | Age-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with nonunion |
| M80.041P | Age-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with malunion |
| M80.041S | Age-related osteoporosis with current pathological fracture, right hand, sequela |
| M80.042A | Age-related osteoporosis with current pathological fracture, left hand, initial encounter for fracture |
| M80.042D | Age-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with routine healing |
| M80.042G | Age-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with delayed healing |
| M80.042K | Age-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with nonunion |
| M80.042P | Age-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with malunion |
| M80.042S | Age-related osteoporosis with current pathological fracture, left hand, sequela |
| M80.051A | Age-related osteoporosis with current pathological fracture, right femur, initial encounter for fracture |
| M80.051D | Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with routine healing |
| M80.051G | Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with delayed healing |
| M80.051K | Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with nonunion |
| M80.051P | Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with malunion |
| M80.051S | Age-related osteoporosis with current pathological fracture, right femur, sequela |
| M80.052A | Age-related osteoporosis with current pathological fracture, left femur, initial encounter for fracture |
| M80.052D | Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with routine healing |
| M80.052G | Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with delayed healing |
| M80.052K | Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with nonunion |
| M80.052P | Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with malunion |
| M80.052S | Age-related osteoporosis with current pathological fracture, left femur, sequela |
| M80.061A | Age-related osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture |
| M80.061D | Age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with routine healing |
| M80.061G | Age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with delayed healing |
| M80.061K | Age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with nonunion |
| M80.061P | Age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with malunion |
| M80.061S | Age-related osteoporosis with current pathological fracture, right lower leg, sequela |
| M80.062A | Age-related osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture |
| M80.062D | Age-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with routine healing |
| M80.062G | Age-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with delayed healing |
| M80.062K | Age-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with nonunion |
| M80.062P | Age-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with malunion |
| M80.062S | Age-related osteoporosis with current pathological fracture, left lower leg, sequela |
| M80.071A | Age-related osteoporosis with current pathological fracture, right ankle and foot, initial encounter for fracture |
| M80.071D | Age-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with routine healing |
| M80.071G | Age-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with delayed healing |
| M80.071K | Age-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with nonunion |
| M80.071P | Age-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with malunion |
| M80.071S | Age-related osteoporosis with current pathological fracture, right ankle and foot, sequela |
| M80.072A | Age-related osteoporosis with current pathological fracture, left ankle and foot, initial encounter for fracture |
| M80.072D | Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with routine healing |
| M80.072G | Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with delayed healing |
| M80.072K | Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with nonunion |
| M80.072P | Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with malunion |
| M80.072S | Age-related osteoporosis with current pathological fracture, left ankle and foot, sequela |
| M80.08XA | Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture |
| M80.08XD | Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing |
| M80.08XG | Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with delayed healing |
| M80.08XK | Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with nonunion |
| M80.08XP | Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with malunion |
| M80.08XS | Age-related osteoporosis with current pathological fracture, vertebra(e), sequela |
| M80.0AXA | Age-related osteoporosis with current pathological fracture, other site, initial encounter for fracture |
| M80.0AXD | Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with routine healing |
| M80.0AXG | Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with delayed healing |
| M80.0AXK | Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with nonunion |
| M80.0AXP | Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with malunion |
| M80.0AXS | Age-related osteoporosis with current pathological fracture, other site, sequela |
| M80.0B1A | Age-related osteoporosis with current pathological fracture, right pelvis, initial encounter for fracture |
| M80.0B1D | Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with routine healing |
| M80.0B1G | Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with delayed healing |
| M80.0B1K | Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with nonunion |
| M80.0B1P | Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with malunion |
| M80.0B1S | Age-related osteoporosis with current pathological fracture, right pelvis, sequela |
| M80.0B2A | Age-related osteoporosis with current pathological fracture, left pelvis, initial encounter for fracture |
| M80.0B2D | Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with routine healing |
| M80.0B2G | Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with delayed healing |
| M80.0B2K | Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with nonunion |
| M80.0B2P | Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with malunion |
| M80.0B2S | Age-related osteoporosis with current pathological fracture, left pelvis, sequela |
| M80.811A | Other osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture |
| M80.811D | Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with routine healing |
| M80.811G | Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing |
| M80.811K | Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with nonunion |
| M80.811P | Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with malunion |
| M80.811S | Other osteoporosis with current pathological fracture, right shoulder, sequela |
| M80.812A | Other osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture |
| M80.812D | Other osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with routine healing |
| M80.812G | Other osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with delayed healing |
| M80.812K | Other osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with nonunion |
| M80.812P | Other osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with malunion |
| M80.812S | Other osteoporosis with current pathological fracture, left shoulder, sequela |
| M80.821A | Other osteoporosis with current pathological fracture, right humerus, initial encounter for fracture |
| M80.821D | Other osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing |
| M80.821G | Other osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with delayed healing |
| M80.821K | Other osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with nonunion |
| M80.821P | Other osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with malunion |
| M80.821S | Other osteoporosis with current pathological fracture, right humerus, sequela |
| M80.822A | Other osteoporosis with current pathological fracture, left humerus, initial encounter for fracture |
| M80.822D | Other osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with routine healing |
| M80.822G | Other osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with delayed healing |
| M80.822K | Other osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with nonunion |
| M80.822P | Other osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with malunion |
| M80.822S | Other osteoporosis with current pathological fracture, left humerus, sequela |
| M80.831A | Other osteoporosis with current pathological fracture, right forearm, initial encounter for fracture |
| M80.831D | Other osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with routine healing |
| M80.831G | Other osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with delayed healing |
| M80.831K | Other osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with nonunion |
| M80.831P | Other osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with malunion |
| M80.831S | Other osteoporosis with current pathological fracture, right forearm, sequela |
| M80.832A | Other osteoporosis with current pathological fracture, left forearm, initial encounter for fracture |
| M80.832D | Other osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with routine healing |
| M80.832G | Other osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with delayed healing |
| M80.832K | Other osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with nonunion |
| M80.832P | Other osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with malunion |
| M80.832S | Other osteoporosis with current pathological fracture, left forearm, sequela |
| M80.841A | Other osteoporosis with current pathological fracture, right hand, initial encounter for fracture |
| M80.841D | Other osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with routine healing |
| M80.841G | Other osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with delayed healing |
| M80.841K | Other osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with nonunion |
| M80.841P | Other osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with malunion |
| M80.841S | Other osteoporosis with current pathological fracture, right hand, sequela |
| M80.842A | Other osteoporosis with current pathological fracture, left hand, initial encounter for fracture |
| M80.842D | Other osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with routine healing |
| M80.842G | Other osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with delayed healing |
| M80.842K | Other osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with nonunion |
| M80.842P | Other osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with malunion |
| M80.842S | Other osteoporosis with current pathological fracture, left hand, sequela |
| M80.851A | Other osteoporosis with current pathological fracture, right femur, initial encounter for fracture |
| M80.851D | Other osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with routine healing |
| M80.851G | Other osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with delayed healing |
| M80.851K | Other osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with nonunion |
| M80.851P | Other osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with malunion |
| M80.851S | Other osteoporosis with current pathological fracture, right femur, sequela |
| M80.852A | Other osteoporosis with current pathological fracture, left femur, initial encounter for fracture |
| M80.852D | Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with routine healing |
| M80.852G | Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with delayed healing |
| M80.852K | Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with nonunion |
| M80.852P | Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with malunion |
| M80.852S | Other osteoporosis with current pathological fracture, left femur, sequela |
| M80.861A | Other osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture |
| M80.861D | Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with routine healing |
| M80.861G | Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with delayed healing |
| M80.861K | Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with nonunion |
| M80.861P | Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with malunion |
| M80.861S | Other osteoporosis with current pathological fracture, right lower leg, sequela |
| M80.862A | Other osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture |
| M80.862D | Other osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with routine healing |
| M80.862G | Other osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with delayed healing |
| M80.862K | Other osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with nonunion |
| M80.862P | Other osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with malunion |
| M80.862S | Other osteoporosis with current pathological fracture, left lower leg, sequela |
| M80.871A | Other osteoporosis with current pathological fracture, right ankle and foot, initial encounter for fracture |
| M80.871D | Other osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with routine healing |
| M80.871G | Other osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with delayed healing |
| M80.871K | Other osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with nonunion |
| M80.871P | Other osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with malunion |
| M80.871S | Other osteoporosis with current pathological fracture, right ankle and foot, sequela |
| M80.872A | Other osteoporosis with current pathological fracture, left ankle and foot, initial encounter for fracture |
| M80.872D | Other osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with routine healing |
| M80.872G | Other osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with delayed healing |
| M80.872K | Other osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with nonunion |
| M80.872P | Other osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with malunion |
| M80.872S | Other osteoporosis with current pathological fracture, left ankle and foot, sequela |
| M80.88XA | Other osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture |
| M80.88XD | Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing |
| M80.88XG | Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with delayed healing |
| M80.88XK | Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with nonunion |
| M80.88XP | Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with malunion |
| M80.88XS | Other osteoporosis with current pathological fracture, vertebra(e), sequela |
| M80.8AXA | Other osteoporosis with current pathological fracture, other site, initial encounter for fracture |
| M80.8AXD | Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with routine healing |
| M80.8AXG | Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with delayed healing |
| M80.8AXK | Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with nonunion |
| M80.8AXP | Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with malunion |
| M80.8AXS | Other osteoporosis with current pathological fracture, other site, sequela |
| M81.0 | Age-related osteoporosis without current pathological fracture |
| M81.8 | Other osteoporosis without current pathological fracture |
Neoplasms (29)
| ICD-10 | Covered diagnosis |
|---|---|
| C50.011 | Malignant neoplasm of nipple and areola, right female breast |
| C50.012 | Malignant neoplasm of nipple and areola, left female breast |
| C50.111 | Malignant neoplasm of central portion of right female breast |
| C50.112 | Malignant neoplasm of central portion of left female breast |
| C50.211 | Malignant neoplasm of upper-inner quadrant of right female breast |
| C50.212 | Malignant neoplasm of upper-inner quadrant of left female breast |
| C50.311 | Malignant neoplasm of lower-inner quadrant of right female breast |
| C50.312 | Malignant neoplasm of lower-inner quadrant of left female breast |
| C50.411 | Malignant neoplasm of upper-outer quadrant of right female breast |
| C50.412 | Malignant neoplasm of upper-outer quadrant of left female breast |
| C50.511 | Malignant neoplasm of lower-outer quadrant of right female breast |
| C50.512 | Malignant neoplasm of lower-outer quadrant of left female breast |
| C50.611 | Malignant neoplasm of axillary tail of right female breast |
| C50.612 | Malignant neoplasm of axillary tail of left female breast |
| C50.811 | Malignant neoplasm of overlapping sites of right female breast |
| C50.812 | Malignant neoplasm of overlapping sites of left female breast |
| C50.911 | Malignant neoplasm of unspecified site of right female breast |
| C50.912 | Malignant neoplasm of unspecified site of left female breast |
| C50.A1 | Malignant inflammatory neoplasm of right breast |
| C50.A2 | Malignant inflammatory neoplasm of left breast |
| C61 | Malignant neoplasm of prostate |
| D05.01 | Lobular carcinoma in situ of right breast |
| D05.02 | Lobular carcinoma in situ of left breast |
| D05.11 | Intraductal carcinoma in situ of right breast |
| D05.12 | Intraductal carcinoma in situ of left breast |
| D05.81 | Other specified type of carcinoma in situ of right breast |
| D05.82 | Other specified type of carcinoma in situ of left breast |
| D05.91 | Unspecified type of carcinoma in situ of right breast |
| D05.92 | Unspecified type of carcinoma in situ of left breast |
Factors influencing health status (11)
| ICD-10 | Covered diagnosis |
|---|---|
| Z48.816 | Encounter for surgical aftercare following surgery on the genitourinary system |
| Z51.89 | Encounter for other specified aftercare |
| Z79.810 | Long term (current) use of selective estrogen receptor modulators (SERMs) |
| Z79.811 | Long term (current) use of aromatase inhibitors |
| Z79.818 | Long term (current) use of other agents affecting estrogen receptors and estrogen levels |
| Z79.899 | Other long term (current) drug therapy |
| Z85.3 | Personal history of malignant neoplasm of breast |
| Z85.46 | Personal history of malignant neoplasm of prostate |
| Z86.000 | Personal history of in-situ neoplasm of breast |
| Z88.8 | Allergy status to other drugs, medicaments and biological substances |
| Z92.29 | Personal history of other drug therapy |
Injury, poisoning & external causes (2)
| ICD-10 | Covered diagnosis |
|---|---|
| T50.995S | Adverse effect of other drugs, medicaments and biological substances, sequela |
| T88.7XXS | Unspecified adverse effect of drug or medicament, sequela |
How to use this list when billing
Put the patient's covered ICD-10 diagnosis on the claim line with J0897 and confirm your documentation supports medical necessity. Match the right product code (reference vs biosimilar) and units, and check the diagnosis against the article for your MAC, since the list above is National Government Services, Inc. policy.
LCD vs. Billing & Coding Article vs. NCD
An LCD (Local Coverage Determination) is a MAC's policy on whether a service is reasonable and necessary in its region, and its companion Billing & Coding Article holds the covered ICD-10 and HCPCS code lists. A NCD (National Coverage Determination), where one exists, applies nationwide. For Denosumab (Prolia, Xgeva), the code lists live in Article A52399 (tied to LCD L33394) — CMS moved code lists out of LCDs and into Articles, which is why the diagnoses live in the Article, not the LCD.
Common Denosumab (Prolia, Xgeva) denial reasons
| What you see | Why | Fix |
|---|---|---|
| CO-50 — not medically necessary | Diagnosis not in the covered list for J0897 | Bill a covered ICD-10 from the groups above, or document an exception |
| Diagnosis/units mismatch | Right dx but wrong product code or unit count | Match the J/Q code and units to the drug actually given (check JZ/JW wastage) |
| Covered by one MAC, denied by another | You used a different region's covered list | Use the Article for your MAC (coverage varies) |
| Non-covered / statutorily excluded dx | Diagnosis is on the non-covered list | Confirm against the Article's non-covered ICD-10 group |
Frequently asked questions
- Is Denosumab (Prolia, Xgeva) covered by Medicare?
- Yes. Denosumab (Prolia, Xgeva) (J0897) is covered under Medicare Part B as a physician-administered drug when billed for a medically necessary, covered diagnosis. Local coverage is defined by National Government Services, Inc. in Billing & Coding Article A52399, tied to LCD L33394.
- What diagnoses are covered for Denosumab (Prolia, Xgeva) (J0897)?
- Medicare lists 409 covered ICD-10 diagnosis codes for J0897 under Article A52399. The full list is on this page, grouped by condition category. Coverage can vary by Medicare Administrative Contractor (MAC); confirm against the article that applies in your state.
- Which Medicare policy covers Denosumab (Prolia, Xgeva)?
- Billing & Coding Article A52399 (v71), tied to LCD L33394 (“Drugs and Biologicals, Coverage of, for Label and Off-Label Uses”), published by National Government Services, Inc. and last updated 03/27/2026.
- Why was my Denosumab (Prolia, Xgeva) claim denied as not medically necessary?
- The most common cause is an ICD-10 diagnosis on the claim that is not in the covered list for J0897. Confirm the patient's diagnosis is in the groups below, that documentation supports medical necessity, and that you are using the article for your MAC.
Related references
Covered is only half the answer.
You know the diagnosis is payable. Now quote the patient before the visit and catch underpayments: get Denosumab (Prolia, Xgeva)'s exact Medicare allowed amount, your payer's rate vs. ASP+6%, and the patient's out-of-pocket — in about 30 seconds, free.
Estimate Denosumab (Prolia, Xgeva) cost & patient owe →Source & verification
- Source
- CMS Medicare Coverage Database — Billing & Coding Article A52399 (v71), LCD L33394 “Drugs and Biologicals, Coverage of, for Label and Off-Label Uses” — National Government Services, Inc..
- CMS article last revised
- 03/27/2026 — the most recent revision CMS has published for this article.
- Page last reviewed by CareCost
- Jun 29, 2026 (coverage data retrieved 2026-06-28; we re-verify against CMS quarterly).
- Code licensing
- ICD-10-CM codes are public domain (CMS/CDC). CPT® codes are AMA-copyrighted and are intentionally not listed here — see the administration-code reference for those.
- Not advice
- This is general billing reference, not legal or billing advice. Always verify against the LCD/Article that applies to your MAC and patient.
- How we build this
- Compiled programmatically from the CMS Coverage API and reviewed by the CareCost Estimate editorial team against the source article. See our methodology and editorial policy.
- Spotted an error?
- Email editorial@carecostestimate.com.