What is the cost of denosumab injection?
|Drug/Comparator||Strength||Average Annual Drug Cost ($)|
|Denosumab (Xgeva)||120 mg||7,482|
|Pamidronate (Aredia)^||30 mg/10 mL 60 mg/10 mL 90 mg/10 mL||6,510 to 8,680|
|Pamidronate (generic)^||30 mg/10 mL 60 mg/10 mL 90 mg/10 mL||1,182 to 1,577|
|Zoledronic acid (Zometa)||4 mg/5 mL||7,203 to 9,604|
What is J0897 used for?
HCPCS code J0897 should be used to report denosumab (Prolia™, Xgeva™) for claims submitted to the Part A and Part B MAC.
Where can I buy denosumab?
Prolia ® can be obtained through a specialty pharmacy or retail pharmacy:
- Pharmacy fills the prescription.
- Patient pays cost-sharing under the pharmacy benefit or Medicare Part D.
- Patient brings their Prolia ® to your office or treatment site for injection by a healthcare provider.
Is denosumab expensive?
Subcutaneous denosumab costs $1,828 per dose and $78 for administration. Base-case results showed mean costs of monthly denosumab treatments ($57,200) appeared more than nine times higher than zoledronic acid every 3 months ($5,667) or every month ($9,290).
What is the cost of zoledronic acid?
PRICE. Zoledronic acid costs approximately $1,250 per dose, given once a year. This course of treatment costs less than one year of intravenous ibandronate (Boniva) given every three months ($1,940), but costs more than one year of any of the oral bisphosphonates given monthly.
How do I bill J0897?
Use J0897, SC injection, denosumab, 1 mg. Use CPT code representing procedure performed, such as 96372, therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular; or 96401, chemotherapy administration, subcutaneous or intramuscular; non-hormonal antineoplastic.
How do you bill a firmagon?
FIRMAGON Is Billed By The Milligram (mg): Starting Dose = 240 mg; Each Subsequent Dose = 80 mg. This information is provided for reference only. The healthcare provider must determine the proper coding for the applicable diagnosis and treatment provided, in his/her medical discretion.
Is denosumab safe?
In clinical trials of women with osteoporosis and low bone mineral density, denosumab has been well tolerated, with overall rates of adverse events and serious adverse events in women treated with denosumab similar to those receiving placebo.
Is denosumab injection chemotherapy?
No. Xgeva is not a chemotherapy drug. It is a targeted treatment, called a monoclonal antibody and is classified as a bone-modifying agent.
What is the HCPCS code for denosumab?
HCPCS code J0897 should be used to report denosumab (Prolia™, Xgeva™) for claims submitted to the Part A and Part B MAC. The administration of denosumab, when billed, should be billed using the therapeutic administration code 96372 (Therapeutic prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular.
How much Denosumab is in one ml of Prolia?
Each 1 mL single-use prefilled syringe of Prolia contains 60 mg denosumab (60 mg/mL solution), 4.7% sorbitol, 17 mM acetate, 0.01% polysorbate 20, Water for Injection (USP), and sodium hydroxide to a pH of 5.2 Zoledronic acid injection is a bisphosphonate indicated for the treatm …
When does Medicare pay for the drug denosumab?
The FDA has approved the use of denosumab (Prolia™). Medicare has determined under Section 1861 (t) that this drug may be paid when it is administered incident to a physician’s service and is determined to be reasonable and necessary. Such determination of reasonable and necessary is currently left to the discretion of the Medicare contractors.
Do you have to correct hypocalcemia before taking denosumab?
Hypocalcemia must be corrected prior to initiation of denosumab therapy. The FDA has approved the use of denosumab (Prolia™). Medicare has determined under Section 1861 (t) that this drug may be paid when it is administered incident to a physician’s service and is determined to be reasonable and necessary.