How do I bill for Prolia injection?

The administration of denosumab, when billed, should be billed using the therapeutic administration code 96372 (Therapeutic prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular.

Does Prolia require prior authorization?

All requests for Xgeva (denosumab), Prolia (denosumab) require a prior authorization and will be screened for medical necessity and appropriateness using the criteria listed below.

What form does Prolia come in?

The recommended dose of Prolia is 60 mg administered as a single subcutaneous injection once every 6 months. Administer Prolia via subcutaneous injection in the upper arm, the upper thigh, or the abdomen.

What is Amgen Prolia?

Prolia is indicated for the treatment of postmenopausal women with osteoporosis at high risk for fracture, defined as a history of osteoporotic fracture, or multiple risk factors for fracture; or patients who have failed or are intolerant to other available osteoporosis therapy.

How much does a shot of Prolia cost?

The majority of commercial and Medicare plans cover Prolia®. The list price for Prolia® is $1,278.79* ,† per treatment every six months. Most patients do not pay the list price.

Is Prolia a chemo drug?

Prolia – Chemotherapy Drugs – Chemocare.

How do you qualify for Prolia?

U.S. Food and Drug Administration (FDA) has approved the use of Prolia®(denosumab) for the treatment of glucocorticoid-induced osteoporosis (GIOP) in men and women at high risk of fracture, defined as a history of osteoporotic fracture, multiple risk factors for fracture, or patients who have failed or are intolerant …

What is the ICD 10 code for osteoporosis?

Age-related osteoporosis without current pathological fracture. M81. 0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.

Is Prolia worth the risk?

Studies have found that Prolia is generally safe and effective to treat osteoporosis and certain types of bone loss. For example, in the studies, people taking Prolia for up to 8 years didn’t have significant side effects compared with people taking a placebo. (A placebo is a treatment with no active drug.)

Does Prolia have to be exactly 6 months apart?

This study does suggest that, only under unforeseen circumstances, when a patient is otherwise unable to receive a subsequent injection of denosumab in a timely manner, then a delay may be acceptable. Otherwise, all patients should continue to receive their subsequent doses every 6 months, as per the product monograph.

What are the dangers of Prolia?

What are the serious side effects of Prolia?

  • severe bone, joint, or muscle pain.
  • serious infections, including serious urinary tract infections or skin infections.
  • unusual fractures in the thigh bone*
  • decreased bone production (bones take longer to form new tissue)

How long can you wait between Prolia injections?

Prolia is an injection that can be self-administered once every six months for the treatment of osteoporosis.

Is there a prescription reimbursement program for Prolia?

Patients should always consult their healthcare provider regarding medical decisions or treatment concerns. Terms, conditions, and program maximums apply. This program is not open to patients receiving prescription reimbursement under any federal, state, or government-funded healthcare program. Not valid where prohibited by law.

Where can I use my MasterCard for Prolia?

This card can be used only to cover co-payment for eligible prescriptions covered under the program at participating merchant locations where Debit MasterCard is accepted. Eligibility Criteria: Open to patients with a Prolia ® (denosumab) prescription and commercial insurance for Prolia ®.

How to enroll in the Prolia co-pay program?

At, registered offices can help patients enroll with a 4-step process To enroll by phone, call 1-844-369-9962 *See eligibility requirements for the Prolia ® Co-pay Program.

How is Prolia used to treat osteoporosis after menopause?

Prolia® is a prescription medicine used to treat osteoporosis in women after menopause who are at high risk for fracture or cannot use another osteoporosis medicine or other osteoporosis medicines did not work well. Prolia® is a prescription medicine used to increase bone mass in men with osteoporosis who are at high risk for fracture.