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Billing Prolia

  1. #1
    Tampa, Florida
    Default Billing Prolia
    Medical Coding Books
    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?


  2. Default 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 and I will be happy to help you.

  3. #3
    Columbus, Ohio
    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)

    I have not been able to locate documentation for CGS for the correct code. Only their allowable.

    If anyone can assist with documentation I would appriciate it!

    Stephanie W, CPC

  4. #4
    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 I can send you my billing and coding guide that was sent to me from our rep. 96372 is the correct admin code.


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