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Question:
What code should be assigned for Prolia?
Answer:
For Prolia injections, assign J0897 (injection, denosumab, 1 mg). In its Targeted Probe and Educate Program guidelines, the Centers for Medicare & Medicaid Services (CMS) state that it is used in patients with osteoporosis at high risk of fracture, females on aromatase therapy for breast cancer, and males on androgen-deprivation therapy. Documentation should include a proof of osteoporosis or cancer treatment, physician order, and administration record.
CPT® copyright 2023 American Medical Association (AMA). All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association.
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