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HCPCS Q5162 · Level II · Part B drug

HCPCS Q5162: Injection, denosumab-nxxp (bildyos/bilprevda), biosimilar, 1 mg

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for Q5162

Billing unit
1 MG
Inj, denosumab-nxxp, 1 mg
ASP payment limit
$15.336
October 2026; -2.1% vs July 2026
Practitioner MUE
none published
CMS publishes no MUE for this code
OPPS status
SI G
APC 0934
NCCI exposure
no PTP pairs
Coverage articles
1
5 states

TL;DR

HCPCS Q5162 is the Level II code for Injection, denosumab-nxxp (bildyos/bilprevda), biosimilar, 1 mg, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $15.336 per billing unit, down 2.1% from July 2026. Under OPPS it carries status indicator G in APC 0934. As a biosimilar it has its own code and ASP; the reference product cannot be billed under this code, and the JZ or JW modifier rules for discarded amounts apply per single-dose vial. With a 1 mg billing unit, a single administration can be hundreds of units; the unit count on the claim must equal the milligrams given, and rounding rules for partial units follow the contractor's guidance. The ASP crosswalk maps 2 NDCs to it, sold as Bildyos, Bilprevda by Organon LLC. 1 Medicare coverage article lists the code across 5 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for Q5162 at $15.336 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $15.66 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for Q5162
QuarterPayment limitPerCoinsurance
October 2026$15.3361 MG20%
July 2026$15.661 MG—
CMS note: 8% of reference add-on applied

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 2 NDCs from 1 labeler to Q5162. Report the NDC in the claim's drug segment and bill the number of Q5162 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to Q5162
NDCDrug nameLabelerPackage sizeBilling units / package
78206-0193-01BildyosOrganon LLC1 × 160
78206-0195-01BilprevdaOrganon LLC1.7 × 1120

Medically Unlikely Edits (MUE)

CMS does not publish an MUE for Q5162 in the 2026 Q4 tables. Some MUE values are confidential and applied without publication, so unit limits can still deny; document the dose and the units calculation on every claim.

NCCI edits and add-on relationships

No active practitioner PTP pair lists Q5162 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

Q5162 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

1 current Medicare Administrative Contractor article lists Q5162 in their HCPCS tables, covering 5 states. Each article carries the covered and non-covered ICD-10 codes that medical-necessity denials (CARC 50) are adjudicated against.

Billing and Coding Articles listing Q5162
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Denosumab (Prolia®, Xgeva®, Jubbonti®) and biosimilarsWellpoint FederalCT IL MN NY WIL33394

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, Q5162 carries status indicator G and is assigned to APC 0934, with a published national unadjusted payment of $15.66. Status G marks pass-through drug payment, which is time-limited.

Common denials for Q5162 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks Q5162 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

Explore QuickCodeExplore QuickRCMBook a demo

Frequently asked questions — HCPCS Q5162

What does HCPCS code Q5162 describe?

Q5162 is defined by CMS as "Injection, denosumab-nxxp (bildyos/bilprevda), biosimilar, 1 mg". Each billing unit represents 1 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for Q5162 in October 2026?

The ASP-based payment limit is $15.336 per 1 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $15.66.

Which NDCs map to Q5162?

The October 2026 ASP crosswalk lists 2 NDCs from 1 labeler: Bildyos (Organon LLC); Bilprevda (Organon LLC). For example NDC 78206-0193-01 is a 1 package equal to 60 billing units. The crosswalk's billing-units-per-package figure converts each package into Q5162 units.

Does Q5162 have NCCI bundling edits?

No active practitioner PTP pairs list Q5162 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Which Medicare coverage articles mention Q5162?

1 current Billing and Coding Article in the Medicare Coverage Database list Q5162, covering 5 states: (Billing and Coding: Denosumab (Prolia®, Xgeva®, Jubbonti®) and biosimilars).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.