New code Q5166: Injection, denosumab-desu (osvyrti/jubereq), biosimilar, 1 mg — effective Jul 1, 2026
Sent Jul 23, 2026 · . This is the issue exactly as subscribers received it.
New code Q5166: Injection, denosumab-desu (osvyrti/jubereq), biosimilar, 1 mg
CMS assigned a new HCPCS code. Claims with dates of service on or after Jul 1, 2026 should use Q5166. Load it into your charge master, billing system, and prior-auth templates.
Code facts
| HCPCS code | Q5166 |
| Descriptor | Injection, denosumab-desu (osvyrti/jubereq), biosimilar, 1 mg |
| 1 billing unit | 1 mg |
| Effective date | Jul 1, 2026 |
Products billed under Q5166
| Product | Package | NDC (11-digit, claim form) | WAC |
|---|---|---|---|
| Osvyrti (denosumab-desu) biosimilar to Prolia — osteoporosis indications |
60 mg/mL single-dose prefilled syringe (1 per pack) | 69448-0021-6310-digit: 69448-021-63 |
$1,800.41 $30.01 per 1 mg |
| Jubereq (denosumab-desu) biosimilar to Xgeva — oncology indications |
120 mg/1.7 mL (70 mg/mL) single-dose vial (1 per carton) | 69448-0022-6310-digit: 69448-022-63 |
$3,311.75 $27.60 per 1 mg |
WAC = wholesale acquisition cost, from the manufacturer's announcement. It is not what any plan pays and excludes discounts and rebates.
Before you bill
- Both products bill under the same code, Q5166 — match the NDC on the claim to the product actually drawn.
- 1 billing unit = 1 mg. A 60 mg Osvyrti dose = 60 units; a 120 mg Jubereq dose = 120 units.
- Do not bill reference J0897 when a Q5166 product was administered — code-to-NDC mismatch is a denial trigger.
- Osvyrti carries a boxed warning for severe hypocalcemia in advanced chronic kidney disease — check the label before first use.
- Q5166 is one of four denosumab biosimilar codes new this quarter (with Q5165 Oziltus, Q5167 Enoby/Xtrenbo, and Q5171 Boncresa) — the family now spans 11 HCPCS codes. Confirm which codes your payers prefer before switching.
No ASP-based Medicare payment limit yet: new codes typically pay from WAC until CMS publishes ASP for them (usually about two quarters after launch). Check your MAC's guidance.
Prolia family billing reference (J0897) → · Xgeva family billing reference → · Biosimilar modifier rules →
Estimating what patients owe on the new code? CareCost re-quotes a patient in about 90 seconds — free during beta.