Intake card: J0897
Generated from CodeRx data on Nov 7, 2026. No patient information is entered or stored. Verify payer requirements before scheduling.
Billing
HCPCS codeJ0897 (active)
Billing unit1 MG
Part B limit$29.856 per unit (Q4 2026)
Max units / day (MUE)Practitioner 120 · Outpatient hospital 120 · DME supplier 0
JW / JZSingle-dose containers on the CMS crosswalk: JW for discarded drug, JZ when none (Medicare Part B).
Medicare
Hospital outpatientK Paid separately (non-pass-through drug or biological) · $29.856 per unit (Q4 2026)
Home infusionPart B pays the drug at home only under the DME benefit (e.g. a pump drug under the External Infusion Pump policy, or IVIG for primary immune deficiency); otherwise Part D. Home infusion therapy services are paid only to Medicare HIT suppliers.
CoverageLCDs and articles for J0897 (Medicare Coverage Database)
Washington Apple Health
Professional claims$29.86 maximum allowable· PASee Prolia/Xgeva Section of the Physician-Related/Professional Services Provider Guide.
Hospital outpatientPaid by EAPG (3M grouper weight × the hospital's conversion factor); certain high-cost drugs are paid outside EAPG.
Home infusionHCA pays supply, pump, and parenteral nutrition codes from its home infusion schedule; per diem S-codes are not on it.
AAC = actual acquisition cost, based on NDC or invoice; BR = by report; NC = not covered; DC = not covered, see a different code; DP = covered under another program (see comments); PA = prior authorization; EPA = expedited prior authorization (see the billing guide); CPA = contractor prior authorization (Qualis). For professional claims; hospital-administered drugs are paid under HCA's outpatient (OPPS/EAPG) rules.
Products
- Prolia (billed with this code)
- Xgeva (billed with this code)
- Aukelso (biosimilar · Q5161)
- Bildyos (biosimilar · Q5162)
- Bilprevda (biosimilar · Q5162)
- Bomyntra (biosimilar · Q5158)
- Boncresa (biosimilar)
- Bosaya (biosimilar · Q5161)
- Conexxence (biosimilar · Q5158)
- Denosumab-bmwo (biosimilar)
- Enoby (biosimilar · Q5167)
- Jubbonti (biosimilar · Q5136)
- Jubereq (biosimilar)
- Osenvelt (biosimilar · Q5157)
- Ospomyv (biosimilar)
- Osvyrti (biosimilar)
- Oziltus (biosimilar)
- Stoboclo (biosimilar · Q5157)
- Wyost (biosimilar · Q5136)
- Xtrenbo (biosimilar · Q5167)
Reference and biosimilar links come from the FDA Purple Book; substitution follows FDA licensure, payer policy, and state law.
NDCs on the current CMS crosswalk (4)
| NDC (11-digit) | Labeler | Package | Container | Units / pkg | Medicaid unit | N4 qualifier |
|---|---|---|---|---|---|---|
| 55513-0710-01 | Amgen Inc | 1 SYRINGE in 1 CARTON (55513-710-01) / 1 mL in 1 SYRINGE | not stated | 60 | ML (Milliliter) | ML |
| 55513-0710-21 | Amgen Inc | 1 SYRINGE in 1 CARTON (55513-710-21) / 1 mL in 1 SYRINGE | not stated | 60 | ML (Milliliter) | ML |
| 55513-0730-01 | Amgen Inc | 1 VIAL, SINGLE-USE in 1 CARTON (55513-730-01) / 1.7 mL in 1 VIAL, SINGLE-USE | single-dose | 120 | ML (Milliliter) | ML |
| 55513-0730-21 | Amgen Inc | 1 VIAL, SINGLE-USE in 1 CARTON (55513-730-21) / 1.7 mL in 1 VIAL, SINGLE-USE | single-dose | 120 | ML (Milliliter) | ML |
Intake checklist
- Confirm the patient's coverage and whether the drug is on the medical or the pharmacy benefit.
- Apple Health (professional claims): PA required — see HCA's prior authorization page.
- Medicare: check the MAC's LCDs and billing articles for covered diagnoses (coverage link below).
- Single-dose container: record any discarded amount (JW line) or bill JZ when none is discarded (Medicare Part B).
- Bill the 11-digit NDC with the N4 qualifier, unit qualifier, and quantity; Apple Health requires the NDC on professionally administered drug claims.
- Home infusion (not a Medicare HIT supplier): Medicare pays the drug at home only under Part B DME rules or as Part D; no Medicare payment for home infusion services.
Calculate units and claim lines · Compare HOPD and home infusion
Disclaimer. This application provides informational coding and reimbursement reference data. It does not constitute legal, clinical, coding, or billing advice. Codes, payment amounts, payer rules, and coverage policies can change. Verify all information with current CMS publications, the applicable payer, and your organization’s compliance policies before submitting a claim. CodeRx is not affiliated with or endorsed by CMS, FDA, Medicare, or any payer.