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    v1.0.30
    OpenPayerBilling CodesTemporary CodesHCPCS hcpcs-q5136-denosumab-biosimilar-injection-1mg
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    HCPCS Level II Q5136: Denosumab-bbdz (biosimilar) injection, 1 mg

    HCPCS Level II code Q5136 represents a 1 mg unit of injection of denosumab-bbdz (biosimilar marketed as Jubbonti/Wyost) used as a biologic monoclonal antibody for conditions requiring RANKL inhibition; service type: injectable biologic medication administration, typical site of service: outpatient infusion or clinic-based injection setting.

    For related coverage guidance, see recent payer policy updates: Truvada (Emtricitabine and Tenofovir Disoproxil Fumarate) for HIV Prevention and Treatment, HIV/AIDS Pharmacologic Prevention and Treatment, Long-Acting Injectable Antiretroviral Agents for HIV.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a postmenopausal woman or adult patient with osteoporosis or bone loss who requires subcutaneous monoclonal antibody therapy to reduce fracture risk. The patient presents to an outpatient infusion clinic, specialty injectable clinic, or physician office for administration of denosumab-bbdz (Q5136) dosed per product labeling. Clinical workflow includes verification of indication and recent bone mineral density or fracture history, medication reconciliation, screening for hypocalcemia and recent dental procedures, obtaining informed consent, documentation of lot number and dose, subcutaneous injection by an authorized clinician (e.g., nurse, advanced practice provider, or physician), observation for immediate adverse reaction (typically 15–30 minutes), and scheduling of follow-up dosing and monitoring (calcium, vitamin D adherence, and dental evaluation as indicated). Typical sites of service are outpatient infusion/injectable clinics, physician offices, and ambulatory care centers; administration may also occur in long-term care facilities for eligible residents.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96372Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscularCommonly reported for the professional administration service when a single subcutaneous injection of denosumab-bbdz is given in an office or clinic
    36415Collection of venous blood by venipunctureOften performed before or after administration to obtain labs such as serum calcium or renal function for monitoring
    96360Intravenous infusion, hydration; initial, 31 minutes to 1 hourMay be billed if IV access and hydration or IV medications are provided as part of managing a reaction (rare for subcutaneous denosumab-bbdz)
    99406Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutesCounseling codes such as this or other E/M or counseling codes may be reported if significant counseling about fracture risk reduction is performed at the visit
    99441Telephone evaluation and management service by a physician or other qualified health care professional, 5-10 minutes of medical discussionPost-administration phone follow-up for adverse event assessment or medication adherence counseling may be reported when payer policy permits

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    207Q00000X
    363A00000X
    208600000X
    343800000X
    363L00000X
    207RA0000X
    246ZC0007X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    E03.9Hypothyroidism, unspecified
    E83.51Hypocalcemia
    M80.00XAAge-related osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture
    M80.011AAge-related osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture
    M80.031AAge-related osteoporosis with current pathological fracture, right forearm, initial encounter for fracture
    M80.032AAge-related osteoporosis with current pathological fracture, left forearm, initial encounter for fracture
    M80.032DAge-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with routine healing
    M80.041AAge-related osteoporosis with current pathological fracture, right hand, initial encounter for fracture
    M80.041DAge-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with routine healing
    M80.042AAge-related osteoporosis with current pathological fracture, left hand, initial encounter for fracture

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: Infectious Disease1 / 3

    10 rows

    PolicyPayerEffective Date
    Truvada (Emtricitabine and Tenofovir Disoproxil Fumarate) for HIV Prevention and Treatmentpremerabluecrossofwashington2026-10-01
    HIV/AIDS Pharmacologic Prevention and Treatmentpremerabluecrossofwashington2026-10-01
    Long-Acting Injectable Antiretroviral Agents for HIVColorado Rocky Mountain Health Plans2026-10-01
    B-Hemolytic Streptococcus TestingOscar Health2026-10-01
    Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance AssaysOscar Health2026-10-01
    Hepatitis Testing (A, B, C, D) Coverage CriteriaOscar Health2026-10-01
    Lyme Disease Testing Coverage CriteriaOscar Health2026-10-01
    Pathogen Panel TestingOscar Health2026-10-01
    Diagnostic Testing of Common Sexually Transmitted InfectionsOscar Health2026-10-01
    Testing for Vector-Borne InfectionsOscar Health2026-10-01

    Related Codes

    HCPCS-LEVEL-II-Q4139-INJECTABLE-AMNIOMATRIX-BIODMATRIX-1-CC

    HCPCS Q4139: Amniomatrix or Biodmatrix, Injectable, 1 cc

    HCPCS-LEVEL-II-Q4256-AREA-BASED-PROCEDURAL-ADD-ON-PER-SQ-CM

    HCPCS Q4256: MLG-complete Skin Graft Material, Per Sq Cm

    HCPCS-LEVEL-II-Q5132-ADALIMUMAB-AFZB-ABRILADA-10MG-INJECTION

    HCPCS Level II Q5132: Injection, adalimumab-afzb (Abrilada), 10 mg

    HCPCS-Q0035-CARDIOKYMOGRAPHY-CARDIAC-MOTION-RECORDING

    HCPCS Level II Q0035: Cardiokymography

    HCPCS-Q0081-INFUSION-THERAPY-NON-CHEMOTHERAPEUTIC-PER-VISIT

    HCPCS Level II Q0081: Infusion Therapy, Non‑Chemotherapeutic, Per Visit

    HCPCS-Q0083-CHEMOTHERAPY-NON-INFUSION-ADMINISTRATION

    HCPCS Q0083: Chemotherapy Administration, Non-Infusion Methods

    HCPCS-Q0084-CHEMOTHERAPY-INFUSION-ADMINISTRATION-PER-VISIT

    HCPCS Q0084: Chemotherapy Infusion Administration, Per Visit

    HCPCS-Q0085-CHEMOTHERAPY-INFUSION-PLUS-OTHER-TECHNIQUES-PER-VISIT

    HCPCS Q0085: Chemotherapy Infusion Plus Other Technique(s), Per Visit

    HCPCS-Q0091-PAP-SMEAR-SPECIMEN-COLLECTION-TRANSPORT

    HCPCS Q0091: Screening Papanicolaou Smear Collection and Transport

    HCPCS-Q0092-PORTABLE-XRAY-EQUIPMENT-SETUP

    HCPCS Q0092: Set-up Portable X-ray Equipment

    Showing 1–10 of 629

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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