# Billing Prolia



## mcubed1205 (Mar 15, 2011)

Has anyone billed for Prolia administered in the office? I was told to use J3490 for the medication and 96372 for the administration. Are these correct and if so, are you getting reimbursed and at what rate? 

Thanks.


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## jmcdaniel (Mar 16, 2011)

*Prolia*

Hey.  I have a Prolia rep here now.  The reimbursement is $872 for Medicare. It is higher for commerical insurance.  The admin fee is around $20.  Those are the correct codes to use. You can also bill an office visit with a 25 modifier if needed.  If you have any questions, you can email me at jmcdanielcpc@gmail.com and I will be happy to help you.


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## stephanie7480 (Sep 21, 2011)

J3490 is a "drug" J3590 is a biologic - Prolia ia a biologic. My research has found that J3590 is the correct code.
This is an article for NGS (MAC) http://apps.ngsmedicare.com/sia/article_a50361.htm

I have not been able to locate documentation for CGS for the correct code. Only their allowable. http://apps.ngsmedicare.com/sia/article_a50361.htm

If anyone can assist with documentation I would appriciate it!

Stephanie W, CPC


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## gina_marie (Sep 28, 2011)

Our Prolia rep said to use J3490.  You have to be sure to put "Prolia (denosumab) 60 mg, SC injection, NDC#55513071001" in box 19.  The $892 is correct, we only do this on Medicare patients but you would increase that rate for non-Medicare patients.  We still have not gotten reimbursed for ours and our Prolia rep said the first time you file for a patient can take a long time.  If you would like to email me at gsavarino@e-mds.com I can send you my billing and coding guide that was sent to me from our rep.  96372 is the correct admin code.  

Gina


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