Q5166 HCPCS code: Injection, denosumab-desu (osvyrti/jubereq), biosimilar, 1 mg
Q5166 is the HCPCS Level II code for injection, denosumab-desu (osvyrti/jubereq), biosimilar, 1 mg. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case.
Code details
| Field | Value |
|---|---|
| Section | Q codes — Temporary codes |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2026-07-01 |
| Last action effective | 2026-07-01 |
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 Q5166
- July 2026: Code appears in this HCPCS release
- 2026-07-01: Q5166 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 Q5166?
Q5166 is the HCPCS Level II code for injection, denosumab-desu (osvyrti/jubereq), biosimilar, 1 mg. Short descriptor: "Inj, denosumab-desu, 1 mg".
Does Medicare cover Q5166?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for Q5166?
Medicare policy articles that cite Q5166 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.
Related Q51 codes
- Q5100 — Injection, ustekinumab-kfce (yesintek), biosimilar, 1 mg
- Q5101 — Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram
- Q5102 — Injection, infliximab, biosimilar, 10 mg
- Q5103 — Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg
- Q5104 — Injection, infliximab-abda, biosimilar, (renflexis), 10 mg
- Q5105 — Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units
- Q5106 — Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units
- Q5107 — Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg
- Q5108 — Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg
- Q5109 — Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg
- Q5110 — Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram
- Q5111 — Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg
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Next steps
- Run a reimbursement report for a device billed under Q5166
- Watch Q5166 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q5166
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.