AAPC - Back to school
Results 1 to 4 of 4

Thread: Billing Prolia

  1. #1
    Join Date
    Apr 2007
    Tampa, Florida

    Default Billing Prolia

    AAPC: Back to School
    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. #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 jmcdanielcpc@gmail.com and I will be happy to help you.

  3. #3
    Join Date
    Apr 2007
    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) 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

  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 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.


Similar Threads

  1. Prolia injections
    By alicia.roberson@wilmed.org in forum Rheumatology
    Replies: 5
    Last Post: 08-06-2015, 02:51 PM
  2. Prolia injection
    By bonzaibex in forum OB/GYN
    Replies: 12
    Last Post: 04-08-2015, 12:47 PM
  3. Billing for Prolia-am I understanding this correctly?
    By ollielooya in forum Medical Coding General Discussion
    Replies: 5
    Last Post: 11-21-2014, 10:00 AM
  4. J0897 Prolia
    By ammontagano in forum Urology
    Replies: 2
    Last Post: 09-24-2012, 11:03 PM
  5. Prolia plus injection
    By DAPHNE JONES in forum Family Practice
    Replies: 4
    Last Post: 11-02-2011, 12:39 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.