What is the administration CPT code for Prolia?

CPT® 96401 is valued at approximately $75, and CPT® 96372 at approximately $25 (Medicare fee schedule).

What is the ICD 10 code for Prolia injection?

Document use of product with J0897, SC injection, denosumab, 1 mg. Report unit of service. For example, 60 units (Prolia® dose is 60 mg, per label). Document appropriate ICD-10-CM diagnosis code(s) corresponding to patient’s diagnosis.

How is Prolia administered?

The recommended dose of Prolia is 60 mg administered as a single subcutaneous injection once every 6 months. Administer Prolia via subcutaneous injection in the upper arm, the upper thigh, or the abdomen.

Where do you inject denosumab?

Denosumab injection comes as a solution (liquid) to be injected subcutaneously (under the skin) in your upper arm, upper thigh, or stomach area. It is usually injected by a doctor or nurse in a medical office or clinic. Denosumab injection (Prolia) is usually given once every 6 months.

What kind of drug is Prolia?

Prolia is a prescription medicine used to treat symptoms of osteoporosis and to increase bone mass in patients receiving certain types of cancer. Prolia may be used alone or with other medications. Prolia belongs to a class of drugs called Antineoplastics, Monoclonal Antibody; Monoclonal Antibodies, Endocrine.

What does CPT code 96372 mean?

The Current Procedural Terminology (CPT) code 96372 as maintained by the American Medical Association, is a medical procedural code under the range – Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes chemotherapy and other highly complex drug or highly complex biologic agent administration); …

How long do you stay on Prolia?

You can keep taking Prolia for as many years as your doctor recommends. Studies of the drug were done over a 3-year period, but it can be used for longer periods of time. Prolia has been shown to be a safe and effective option for treating osteoporosis and reducing bone loss.

Is the Prolia injection painful?

The most common adverse reactions reported with Prolia in patients with postmenopausal osteoporosis are back pain, pain in extremity, musculoskeletal pain, hypercholesterolemia, and cystitis. The most common adverse reactions reported with Prolia in men with osteoporosis are back pain, arthralgia, and nasopharyngitis.

Which is the correct administration code for Prolia?

Based on our local coverage article, it appears that CPT 96372 would be an appropriate administration code for Prolia when used to treat osteoporosis. However, since Xgeva is classified as a monoclonal antibody, CPT 96401 appears to be a more appropriate administration code.

What happens if you discontinue the use of Prolia?

Following discontinuation of Prolia ® treatment, fracture risk increases, including the risk of multiple vertebral fractures. Evaluate an individual’s benefit/risk before initiating treatment with Prolia ® .

Which is the proper administration code 96372 or 96401?

Is the proper administration code 96372 or 96401. Received various answers in reference to which administration code is the correct code to us for J0897. Apparently UHC-Medicare wants us to us 96372. I received information the Medicare will accept 96401 . Will Medicare except either administration code 96401 or 96372?

How long do you give Prolia for HCPs?

Give your patients 6 months of therapy with each dose of Prolia®1 Single-use prefilled 1 mL syringe The image above is for illustration purposes only and represents a snapshot in time.