Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
J6 · Effective Oct 1, 2015
3 active Medicare policies list J0897, and 41 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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J6 · Effective Oct 1, 2015
JK · Effective Oct 1, 2015
J6 · Effective Jul 1, 2026
41 policies from 22 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
Showing 10 of 14 · All EviCore by Evernorth policies
| Policy | Effective | Status of J0897 |
|---|---|---|
| Denosumab (Prolia)Effective 01/01/2020 - 08/30/2020 | Jan 1, 2020 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Denosumab (Prolia)Effective 07/01/2022 - 06/30/2023 | Jul 1, 2022 | Prior auth requiredInferred from policy title |
| Denosumab (Prolia)Effective 07/01/2023 - 05/31/2024 | Jul 1, 2023 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Denosumab (Prolia)Effective 08/01/2021 - 06/30/2022 | Aug 1, 2021 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Denosumab (Prolia)Effective 09/01/2020 - 07/31/2021 | Sep 1, 2020 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Denosumab (Prolia)Effective 12/01/2018 - 12/31/2019 | Dec 1, 2018 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Denosumab Products (Prolia, Jubbonti, Stoboclo, Conexxence, Bildyos, Ospomyv, Bosaya, Enoby, Osvyrti) Non-oncologyEffective 10/01/2026 | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Denosumab Products (Prolia, Jubbonti, Stoboclo, Conexxence, Bildyos, Ospomyv, Bosaya, Enoby) Non-oncology | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Denosumab Products (Prolia, Jubbonti, Stoboclo, Conexxence, Bildyos, Ospomyv) Non-oncologyEffective 02/01/2026 - 05/31/2026 | Feb 1, 2026 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Denosumab Products (Prolia, Jubbonti, Stoboclo, Conexxence) Non-oncologyEffective 11/01/2025 - 01/31/2026 | Nov 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Policy | Effective | Status of J0897 |
|---|---|---|
| Denosumab (Prolia, Xgeva) and related biosimilars, and Romosozumab-aqqg (Evenity) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Denosumab (Prolia, Xgeva) and related biosimilars, and Romosozumab-aqqg (Evenity) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Denosumab (Prolia, Xgeva) and related biosimilars, and Romosozumab-aqqg (Evenity) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Denosumab (Prolia, Xgeva) and related biosimilars, and Romosozumab-aqqg (Evenity) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Prolia (denosumab) and Biosimilar | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Prolia (denosumab) and Biosimilars | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Denosumab | Oct 1, 2026 | Covered |
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Denosumab | Oct 1, 2026 | Covered |
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Denosumab | Oct 1, 2026 | Covered |
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Denosumab ( e.g., Xgeva and Prolia) and Biosimilars | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Denosumab and Biosimilars for Non-Oncologic Indications | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Denosumab and Biosimilars for Non-Oncologic Indications | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Denosumab and Biosimilars for Non-Oncologic Indications | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Denosumab and Biosimilars for Non-Oncologic Indications | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0897 |
|---|---|---|
| DENOSUMAB (PROLIA/XGEVA) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Denosumab Prolia Xgeva | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Denosumab Products: (Prolia); Denosumab-nxxp (Bildyos); Denosumab-mobz (Boncresa);Denosumab-kyqq (Bosaya); Denosumab-bnht (Conexxence); Denosumab-qbde (Enoby); Denosumab-bbdz (Jubbonti); Denosumab-dssb (Ospomyv); Denosumab-desu (Osvyrti); Denosumab-bmwo (Stoboclo | Nov 13, 2010 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Cigna MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Prolia (Denosumab) and Biosimilars | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Denosumab (Prolia, Xgeva and biosimilars); CP.PHAR.58 | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Q4 - 2026 JHP MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Denosumab (Prolia, Xgeva) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0897 |
|---|---|---|
| 00265 denosumab (Prolia, biosimilars) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0897 |
|---|---|---|
| Denosumab: Prolia; Jubbonti; Ospomyv; Stoboclo; Denosumab-dssb; Conexxence; Denosumab-bnht; Xgeva; Wyost; Xbryk; Osenvelt; Bomyntra | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |