Q5173 HCPCS code: Injection, denosumab-adet (ponlimsi), biosimilar, 1 mg
Q5173 is the HCPCS Level II code for injection, denosumab-adet (ponlimsi), 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 | 2026-10-01 |
| Last action effective | 2026-10-01 |
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 Q5173
- October 2026: Code appears in this HCPCS release
- 2026-10-01: Q5173 added to HCPCS Level II
- 2026-10-01: Last CMS action: code added
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code Q5173?
Q5173 is the HCPCS Level II code for injection, denosumab-adet (ponlimsi), biosimilar, 1 mg. Short descriptor: "Inj, denosumab-adet, 1 mg".
Does Medicare cover Q5173?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for Q5173?
Medicare policy articles that cite Q5173 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 Q5173
- Watch Q5173 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q5173
Compiled by Caduvo from public CMS (Medicare) records, HCPCS release October 2026. Fees are Medicare allowables, not commercial rates. Not reviewed or endorsed by CMS. Not billing or legal advice. Report an error. Data and corrections policy.