J0897 HCPCS code: Injection, denosumab, 1 mg
J0897 is the HCPCS Level II code for injection, denosumab, 1 mg. In 2024 Medicare paid an average of $20.27 per service for J0897 across 55,345,841 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 120 per day on outpatient hospital claims. In 2024, about 32,526 clinicians billed Medicare for J0897 for 445,617 beneficiaries; Florida, California, Texas accounted for 29% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2012-01-01 |
| Last action effective | 2026-07-01 |
Who bills J0897 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 32,526 |
| Medicare beneficiaries | 445,617 |
| States with claims | 55 |
| Share of services in top 3 states (Florida, California, Texas) | 29% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0897, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 55,437,843 | 429,556 | $21.36 | $16.88 |
| 2023 | 55,698,967 | 439,633 | $22.98 | $18.17 |
| 2024 | 55,345,841 | 445,617 | $25.34 | $20.27 |
States with the most J0897 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 6,657,176 | $20.38 |
| California | 5,982,259 | $20.16 |
| Texas | 3,418,515 | $20.31 |
| Pennsylvania | 2,915,981 | $20.38 |
| New York | 2,751,826 | $20.27 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 120 | Prescribing Information |
| practitioner claims | 120 | Prescribing Information |
Medicare policy articles for this code
- A52399: Billing and Coding: Denosumab (Prolia®, Xgeva®, Jubbonti®) and biosimilars (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (434 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| C33 | Malignant neoplasm of trachea | 1 |
| C34.00 | Malignant neoplasm of unspecified main bronchus | 1 |
| C34.01 | Malignant neoplasm of right main bronchus | 1 |
| C34.02 | Malignant neoplasm of left main bronchus | 1 |
| C34.10 | Malignant neoplasm of upper lobe, unspecified bronchus or lung | 1 |
| C34.11 | Malignant neoplasm of upper lobe, right bronchus or lung | 1 |
| C34.12 | Malignant neoplasm of upper lobe, left bronchus or lung | 1 |
| C34.2 | Malignant neoplasm of middle lobe, bronchus or lung | 1 |
| C34.30 | Malignant neoplasm of lower lobe, unspecified bronchus or lung | 1 |
| C34.31 | Malignant neoplasm of lower lobe, right bronchus or lung | 1 |
Showing 10 of 434. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J0897
- 2012-01-01: J0897 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J0897?
J0897 is the HCPCS Level II code for injection, denosumab, 1 mg. Short descriptor: "Denosumab injection".
How much does Medicare pay for J0897?
In 2024, the average Medicare payment was $20.27 per service (average allowed $25.34).
Does Medicare cover J0897?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J0897?
Medicare policy articles that cite J0897 list 434 covered ICD-10-CM diagnosis codes across 1 article. The most cited include C33 (Malignant neoplasm of trachea), C34.00 (Malignant neoplasm of unspecified main bronchus), C34.01 (Malignant neoplasm of right main bronchus). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J0897 can be billed per day?
120 on outpatient hospital claims; 120 on practitioner claims (NCCI medically unlikely edits).
Related J08 codes
- J0800 — Injection, corticotropin, up to 40 units
- J0801 — Injection, corticotropin (acthar gel), up to 40 units
- J0802 — Injection, corticotropin (ani), up to 40 units
- J0833 — Injection, cosyntropin, not otherwise specified, 0.25 mg
- J0834 — Injection, cosyntropin, 0.25 mg
- J0840 — Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram
- J0841 — Injection, crotalidae immune f(ab')2 (equine), 120 mg
- J0850 — Injection, cytomegalovirus immune globulin intravenous (human), per vial
- J0870 — Injection, imetelstat, 1 mg
- J0871 — Injection, daptomycin (endo), not therapeutically equivalent to j0878, 1 mg
- J0872 — Injection, daptomycin (xellia), unrefrigerated, not therapeutically equivalent to j0878 or j0873, 1 mg
- J0873 — Injection, daptomycin (xellia), not therapeutically equivalent to j0878 or j0872, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J0897
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Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.