Q5167, Injection, denosumab-qbde (enoby/xtrenbo), biosimilar, 1 mg
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Authorization is for no more than 12 months
Key Coverage Criteria
- Initiation of denosumab (for glucocorticoid-induced osteoporosis) requires: diagnosis of glucocorticoid-induced osteoporosis; high fracture risk; dosing per FDA labeling; authorization for up to 12 months. Reauthorization requires positive clinical response, FDA-label dosing, and up to 12 months.
- Denosumab is proven for the treatment of postmenopausal patients with osteoporosis or to increase bone mass in patients with osteoporosis at high risk for fracture when all of the following criteria are met: Initial Therapy o Diagnosis of osteoporosis; and o Patient is at high risk for fracture (e.g., history of osteoporotic fracture, multiple risk factors for fracture, patients who have failed or are intolerant to other available osteoporosis therapy); and o Dosing is i [...]
3 Active Policies
UHC-POL-denosumab-prolia-xgeva, Denosumab
UMR-POL-UMR-denosumab-prolia-xgeva, Denosumab
SUREST-POL-SUREST-denosumab-prolia-xgeva, Denosumab
Related Codes
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