Billing and Coding: Ibandronate Sodium

Medicare Coverage Database article A52421

Article

Contractor: Wellpoint Federal
States (A/B MAC): CT, IL, MA, ME, MN, NH, NY, RI, VT, WI
Effective: Apr 1, 2026
Contractor numbers: 06101, 06102, 06201, 06202, 06301, 06302, 13101, 13102, 13201, 13202, 13282, 13292, 14111, 14112, 14211, 14212, 14311, 14312, 14411, 14412, 14511, 14512
Official article: A52421 on cms.gov (version 23)

Read the article's coding instructions on CMS — which codes go together, documentation, and frequency limits — before billing. CodeRx lists the codes, not the instructions.

Drug codes in this article

HCPCS Level II drug codes the article lists (other codes it lists are not shown).

J1740 Ibandronate sodium injection

Covered ICD-10-CM codes (254)

Diagnosis codes the article lists as supporting medical necessity, grouped as in the article, with CMS's descriptions.

Group 1 · 21 codes

C79.51Secondary malignant neoplasm of bone
E83.52Hypercalcemia
M88.0Osteitis deformans of skull
M88.1Osteitis deformans of vertebrae
M88.811Osteitis deformans of right shoulder
M88.812Osteitis deformans of left shoulder
M88.821Osteitis deformans of right upper arm
M88.822Osteitis deformans of left upper arm
M88.831Osteitis deformans of right forearm
M88.832Osteitis deformans of left forearm
M88.841Osteitis deformans of right hand
M88.842Osteitis deformans of left hand
M88.851Osteitis deformans of right thigh
M88.852Osteitis deformans of left thigh
M88.861Osteitis deformans of right lower leg
M88.862Osteitis deformans of left lower leg
M88.871Osteitis deformans of right ankle and foot
M88.872Osteitis deformans of left ankle and foot
M88.88Osteitis deformans of other bones
M88.89Osteitis deformans of multiple sites
M88.9Osteitis deformans of unspecified bone

Group 2 · 207 codes

M80.011AAge-related osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture
M80.011DAge-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with routine healing
M80.011GAge-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing
M80.011KAge-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with nonunion
M80.011PAge-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with malunion
M80.011SAge-related osteoporosis with current pathological fracture, right shoulder, sequela
M80.012AAge-related osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture
M80.012DAge-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with routine healing
M80.012GAge-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with delayed healing
M80.012KAge-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with nonunion
M80.012PAge-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with malunion
M80.012SAge-related osteoporosis with current pathological fracture, left shoulder, sequela
M80.021AAge-related osteoporosis with current pathological fracture, right humerus, initial encounter for fracture
M80.021DAge-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing
M80.021GAge-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with delayed healing
M80.021KAge-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with nonunion
M80.021PAge-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with malunion
M80.021SAge-related osteoporosis with current pathological fracture, right humerus, sequela
M80.022AAge-related osteoporosis with current pathological fracture, left humerus, initial encounter for fracture
M80.022DAge-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with routine healing
M80.022GAge-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with delayed healing
M80.022KAge-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with nonunion
M80.022PAge-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with malunion
M80.022SAge-related osteoporosis with current pathological fracture, left humerus, sequela
M80.031AAge-related osteoporosis with current pathological fracture, right forearm, initial encounter for fracture
M80.031DAge-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with routine healing
M80.031GAge-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with delayed healing
M80.031KAge-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with nonunion
M80.031PAge-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with malunion
M80.031SAge-related osteoporosis with current pathological fracture, right forearm, sequela
M80.032AAge-related osteoporosis with current pathological fracture, left forearm, initial encounter for fracture
M80.032DAge-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with routine healing
M80.032GAge-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with delayed healing
M80.032KAge-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with nonunion
M80.032PAge-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with malunion
M80.032SAge-related osteoporosis with current pathological fracture, left forearm, sequela
M80.041AAge-related osteoporosis with current pathological fracture, right hand, initial encounter for fracture
M80.041DAge-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with routine healing
M80.041GAge-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with delayed healing
M80.041KAge-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with nonunion
M80.041PAge-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with malunion
M80.041SAge-related osteoporosis with current pathological fracture, right hand, sequela
M80.042AAge-related osteoporosis with current pathological fracture, left hand, initial encounter for fracture
M80.042DAge-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with routine healing
M80.042GAge-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with delayed healing
M80.042KAge-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with nonunion
M80.042PAge-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with malunion
M80.042SAge-related osteoporosis with current pathological fracture, left hand, sequela
M80.051AAge-related osteoporosis with current pathological fracture, right femur, initial encounter for fracture
M80.051DAge-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with routine healing
M80.051GAge-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with delayed healing
M80.051KAge-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with nonunion
M80.051PAge-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with malunion
M80.051SAge-related osteoporosis with current pathological fracture, right femur, sequela
M80.052AAge-related osteoporosis with current pathological fracture, left femur, initial encounter for fracture
M80.052DAge-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with routine healing
M80.052GAge-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with delayed healing
M80.052KAge-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with nonunion
M80.052PAge-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with malunion
M80.052SAge-related osteoporosis with current pathological fracture, left femur, sequela
M80.061AAge-related osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture
M80.061DAge-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with routine healing
M80.061GAge-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with delayed healing
M80.061KAge-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with nonunion
M80.061PAge-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with malunion
M80.061SAge-related osteoporosis with current pathological fracture, right lower leg, sequela
M80.062AAge-related osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture
M80.062DAge-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with routine healing
M80.062GAge-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with delayed healing
M80.062KAge-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with nonunion
M80.062PAge-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with malunion
M80.062SAge-related osteoporosis with current pathological fracture, left lower leg, sequela
M80.071AAge-related osteoporosis with current pathological fracture, right ankle and foot, initial encounter for fracture
M80.071DAge-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with routine healing
M80.071GAge-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with delayed healing
M80.071KAge-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with nonunion
M80.071PAge-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with malunion
M80.071SAge-related osteoporosis with current pathological fracture, right ankle and foot, sequela
M80.072AAge-related osteoporosis with current pathological fracture, left ankle and foot, initial encounter for fracture
M80.072DAge-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with routine healing
M80.072GAge-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with delayed healing
M80.072KAge-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with nonunion
M80.072PAge-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with malunion
M80.072SAge-related osteoporosis with current pathological fracture, left ankle and foot, sequela
M80.08XAAge-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.08XDAge-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing
M80.08XGAge-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with delayed healing
M80.08XKAge-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with nonunion
M80.08XPAge-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with malunion
M80.08XSAge-related osteoporosis with current pathological fracture, vertebra(e), sequela
M80.0AXAAge-related osteoporosis with current pathological fracture, other site, initial encounter for fracture
M80.0AXDAge-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with routine healing
M80.0AXGAge-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with delayed healing
M80.0AXKAge-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with nonunion
M80.0AXPAge-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with malunion
M80.0AXSAge-related osteoporosis with current pathological fracture, other site, sequela
M80.0B1AAge-related osteoporosis with current pathological fracture, right pelvis, initial encounter for fracture
M80.0B1DAge-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with routine healing
M80.0B1GAge-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with delayed healing
M80.0B1KAge-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with nonunion
M80.0B1PAge-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with malunion
M80.0B1SAge-related osteoporosis with current pathological fracture, right pelvis, sequela
M80.0B2AAge-related osteoporosis with current pathological fracture, left pelvis, initial encounter for fracture
M80.0B2DAge-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with routine healing
M80.0B2GAge-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with delayed healing
M80.0B2KAge-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with nonunion
M80.0B2PAge-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with malunion
M80.0B2SAge-related osteoporosis with current pathological fracture, left pelvis, sequela
M80.811AOther osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture
M80.811DOther osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with routine healing
M80.811GOther osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing
M80.811KOther osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with nonunion
M80.811POther osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with malunion
M80.811SOther osteoporosis with current pathological fracture, right shoulder, sequela
M80.812AOther osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture
M80.812DOther osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with routine healing
M80.812GOther osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with delayed healing
M80.812KOther osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with nonunion
M80.812POther osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with malunion
M80.812SOther osteoporosis with current pathological fracture, left shoulder, sequela
M80.821AOther osteoporosis with current pathological fracture, right humerus, initial encounter for fracture
M80.821DOther osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing
M80.821GOther osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with delayed healing
M80.821KOther osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with nonunion
M80.821POther osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with malunion
M80.821SOther osteoporosis with current pathological fracture, right humerus, sequela
M80.822AOther osteoporosis with current pathological fracture, left humerus, initial encounter for fracture
M80.822DOther osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with routine healing
M80.822GOther osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with delayed healing
M80.822KOther osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with nonunion
M80.822POther osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with malunion
M80.822SOther osteoporosis with current pathological fracture, left humerus, sequela
M80.831AOther osteoporosis with current pathological fracture, right forearm, initial encounter for fracture
M80.831DOther osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with routine healing
M80.831GOther osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with delayed healing
M80.831KOther osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with nonunion
M80.831POther osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with malunion
M80.831SOther osteoporosis with current pathological fracture, right forearm, sequela
M80.832AOther osteoporosis with current pathological fracture, left forearm, initial encounter for fracture
M80.832DOther osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with routine healing
M80.832GOther osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with delayed healing
M80.832KOther osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with nonunion
M80.832POther osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with malunion
M80.832SOther osteoporosis with current pathological fracture, left forearm, sequela
M80.841AOther osteoporosis with current pathological fracture, right hand, initial encounter for fracture
M80.841DOther osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with routine healing
M80.841GOther osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with delayed healing
M80.841KOther osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with nonunion
M80.841POther osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with malunion
M80.841SOther osteoporosis with current pathological fracture, right hand, sequela
M80.842AOther osteoporosis with current pathological fracture, left hand, initial encounter for fracture
M80.842DOther osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with routine healing
M80.842GOther osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with delayed healing
M80.842KOther osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with nonunion
M80.842POther osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with malunion
M80.842SOther osteoporosis with current pathological fracture, left hand, sequela
M80.851AOther osteoporosis with current pathological fracture, right femur, initial encounter for fracture
M80.851DOther osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with routine healing
M80.851GOther osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with delayed healing
M80.851KOther osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with nonunion
M80.851POther osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with malunion
M80.851SOther osteoporosis with current pathological fracture, right femur, sequela
M80.852AOther osteoporosis with current pathological fracture, left femur, initial encounter for fracture
M80.852DOther osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with routine healing
M80.852GOther osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with delayed healing
M80.852KOther osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with nonunion
M80.852POther osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with malunion
M80.852SOther osteoporosis with current pathological fracture, left femur, sequela
M80.861AOther osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture
M80.861DOther osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with routine healing
M80.861GOther osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with delayed healing
M80.861KOther osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with nonunion
M80.861POther osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with malunion
M80.861SOther osteoporosis with current pathological fracture, right lower leg, sequela
M80.862AOther osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture
M80.862DOther osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with routine healing
M80.862GOther osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with delayed healing
M80.862KOther osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with nonunion
M80.862POther osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with malunion
M80.862SOther osteoporosis with current pathological fracture, left lower leg, sequela
M80.871AOther osteoporosis with current pathological fracture, right ankle and foot, initial encounter for fracture
M80.871DOther osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with routine healing
M80.871GOther osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with delayed healing
M80.871KOther osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with nonunion
M80.871POther osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with malunion
M80.871SOther osteoporosis with current pathological fracture, right ankle and foot, sequela
M80.872AOther osteoporosis with current pathological fracture, left ankle and foot, initial encounter for fracture
M80.872DOther osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with routine healing
M80.872GOther osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with delayed healing
M80.872KOther osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with nonunion
M80.872POther osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with malunion
M80.872SOther osteoporosis with current pathological fracture, left ankle and foot, sequela
M80.88XAOther osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.88XDOther osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing
M80.88XGOther osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with delayed healing
M80.88XKOther osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with nonunion
M80.88XPOther osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with malunion
M80.88XSOther osteoporosis with current pathological fracture, vertebra(e), sequela
M80.8AXAOther osteoporosis with current pathological fracture, other site, initial encounter for fracture
M80.8AXDOther osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with routine healing
M80.8AXGOther osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with delayed healing
M80.8AXKOther osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with nonunion
M80.8AXPOther osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with malunion
M80.8AXSOther osteoporosis with current pathological fracture, other site, sequela
M81.0Age-related osteoporosis without current pathological fracture
M81.6Localized osteoporosis [Lequesne]
M81.8Other osteoporosis without current pathological fracture

Group 3 · 11 codes

K20.80Other esophagitis without bleeding
K20.81Other esophagitis with bleeding
K20.90Esophagitis, unspecified without bleeding
K20.91Esophagitis, unspecified with bleeding
T50.995AAdverse effect of other drugs, medicaments and biological substances, initial encounter
T50.995DAdverse effect of other drugs, medicaments and biological substances, subsequent encounter
T50.995SAdverse effect of other drugs, medicaments and biological substances, sequela
Y63.8Failure in dosage during other surgical and medical care
Z87.19Personal history of other diseases of the digestive system
Z91.89Other specified personal risk factors, not elsewhere classified
Z92.89Personal history of other medical treatment

Group 4 · 9 codes

M85.80Other specified disorders of bone density and structure, unspecified site
M85.831Other specified disorders of bone density and structure, right forearm
M85.832Other specified disorders of bone density and structure, left forearm
M85.851Other specified disorders of bone density and structure, right thigh
M85.852Other specified disorders of bone density and structure, left thigh
M85.88Other specified disorders of bone density and structure, other site
M85.89Other specified disorders of bone density and structure, multiple sites
M85.9Disorder of bone density and structure, unspecified
M89.9Disorder of bone, unspecified

Group 5 · 6 codes

E28.310Symptomatic premature menopause
E28.319Asymptomatic premature menopause
E89.40Asymptomatic postprocedural ovarian failure
E89.41Symptomatic postprocedural ovarian failure
N95.1Menopausal and female climacteric states
Z78.0Asymptomatic menopausal state

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