Denosumab injection
Products billed under this code include Prolia, Xgeva.
Payment limit per 1 MG, by effective quarter, 1Q21 to 4Q26. Gaps mean the code was not in that quarter’s file, or CMS gave no payment limit.Products billed under J0897
From the 4Q26 NDC–HCPCS crosswalk. “Limit / pkg” is the 4Q26 payment limit times the billing units in one package.
| Product | Labeler | NDC | Units / pkg | Limit / pkg |
|---|---|---|---|---|
| Prolia | Amgen Inc | 55513-0710-01 | 60 | $1,791.36 |
| Prolia | Amgen Inc | 55513-0710-21 | 60 | $1,791.36 |
| Xgeva | Amgen Inc | 55513-0730-01 | 120 | $3,582.72 |
| Xgeva | Amgen Inc | 55513-0730-21 | 120 | $3,582.72 |
Every quarter
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $29.856 | −$0.245 | 1 MG | Denosumab injection | v1, posted September 17, 2026 |
| 3Q26 | $30.101 | +$0.594 | 1 MG | Denosumab injection | v1, posted September 15, 2026 |
| 2Q26 | $29.507 | +$0.05 | 1 MG | Denosumab injection | v1, posted September 15, 2026 |
| 1Q26 | $29.457 | +$0.077 | 1 MG | Denosumab injection | v1, posted September 15, 2026 |
| 4Q25 | $29.38 | +$0.143 | 1 MG | Denosumab injection | v1, posted September 8, 2026 |
| 3Q25 | $29.237 | +$1.428 | 1 MG | Denosumab injection | v1, posted March 10, 2026 |
| 2Q25 | $27.809 | +$0.153 | 1 MG | Denosumab injection | v1, posted March 10, 2026 |
| 1Q25 | $27.656 | +$0.696 | 1 MG | Denosumab injection | v1, posted December 19, 2025 |
| 4Q24 | $26.96 | +$0.211 | 1 MG | Denosumab injection | v1, posted June 11, 2025 |
| 3Q24 | $26.749 | +$1.56 | 1 MG | Denosumab injection | v1, posted June 11, 2025 |
| 2Q24 | $25.189 | −$0.009 | 1 MG | Denosumab injection | v1, posted March 11, 2025 |
| 1Q24 | $25.198 | +$0.981 | 1 MG | Denosumab injection | v1, posted December 19, 2024 |
| 4Q23 | $24.217 | +$0.025 | 1 MG | Denosumab injection | v1, posted October 10, 2024 |
| 3Q23 | $24.192 | +$1.174 | 1 MG | Denosumab injection | v1, posted June 5, 2024 |
| 2Q23 | $23.018 | −$0.049 | 1 MG | Denosumab injection | v1, posted February 23, 2024 |
| 1Q23 | $23.067 | +$0.557 | 1 MG | Denosumab injection | v1, posted December 6, 2023 |
| 4Q22 | $22.51 | +$0.255 | 1 MG | Denosumab injection | v1, posted June 22, 2023 |
| 3Q22 | $22.255 | +$0.995 | 1 MG | Denosumab injection | v1, posted June 9, 2023 |
| 2Q22 | $21.26 | +$0.055 | 1 MG | Denosumab injection | v1, posted December 14, 2022 |
| 1Q22 | $21.205 | +$0.016 | 1 MG | Denosumab injection | v1, posted June 8, 2022 |
| 4Q21 | $21.189 | +$0.217 | 1 MG | Denosumab injection | v1, posted June 2, 2022 |
| 3Q21 | $20.972 | +$0.878 | 1 MG | Denosumab injection | v1, posted June 2, 2022 |
| 2Q21 | $20.094 | −$0.013 | 1 MG | Denosumab injection | v1, posted March 1, 2022 |
| 1Q21 | $20.107 | – | 1 MG | Denosumab injection | v1, posted December 10, 2021 |
“Change” is the difference from the previous quarter, shown only when both quarters have a payment limit and the billing unit is the same. “vs. last quarter” and “vs. a year ago” follow the same rule.
CMS source files
- 4Q26: 2026-09-17_october-2026-medicare-part-b-payment-limit-files-final.zipposted September 17, 2026
- 4Q26: 2026-09-17_october-2026-ndc-hcpcs-crosswalk-final.zipposted September 17, 2026
- 3Q26: 2026-09-15_july-2026-medicare-part-b-payment-limit-files.zipposted September 15, 2026
- 2Q26: 2026-09-15_april-2026-medicare-part-b-payment-limit-files-final-file.zipposted September 15, 2026
- 1Q26: 2026-09-15_january-2026-medicare-part-b-payment-limit-files.zipposted September 15, 2026
- 4Q25: 2026-09-08_october-2025-asp-pricing-final-file.zipposted September 8, 2026
- 3Q25: 2026-03-10_july-2025-asp-pricing-file.zipposted March 10, 2026
- 2Q25: 2026-03-10_april-2025-asp-pricing-file.zipposted March 10, 2026
- 1Q25: 2025-12-19_january-2025-asp-pricing-file-03-11-25-final-file.zipposted December 19, 2025
- 4Q24: 2025-06-11_october-2024-asp-pricing-file.zipposted June 11, 2025
- 3Q24: 2025-06-11_july-2024-asp-pricing-file.zipposted June 11, 2025
- 2Q24: 2025-03-11_april-2024-asp-pricing-file.zipposted March 11, 2025
- 1Q24: 2024-12-19_january-2024-asp-pricing-file.zipposted December 19, 2024
- 4Q23: 2024-10-10_october-2023-asp-pricing-file.zipposted October 10, 2024
- 3Q23: 2024-06-05_july-2023-asp-pricing-file.zipposted June 5, 2024
- 2Q23: 2024-02-23_april-2023-asp-pricing-file.zipposted February 23, 2024
- 1Q23: 2023-12-06_january-2023-asp-pricing-file.zipposted December 6, 2023
- 4Q22: 2023-06-22_october-2022-asp-pricing-file.zipposted June 22, 2023
- 3Q22: 2023-06-09_july-2022-asp-pricing-file.zipposted June 9, 2023
- 2Q22: 2022-12-14_april-2022-asp-pricing-file.zipposted December 14, 2022
- 1Q22: 2022-06-08_january-2022-asp-pricing-file.zipposted June 8, 2022
- 4Q21: 2022-06-02_october-2021-asp-pricing-file.zipposted June 2, 2022
- 3Q21: 2022-06-02_july-2021-asp-pricing-file.zipposted June 2, 2022
- 2Q21: 2022-03-01_april-2021-asp-pricing-file.zipposted March 1, 2022
- 1Q21: 2021-12-10_january-2021-asp-pricing-file.zipposted December 10, 2021