Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
J6 · Effective Oct 1, 2015
3 active Medicare policies list Q5136, and 22 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 Mar 1, 2026
22 policies from 12 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.
| Policy | Effective | Status of Q5136 |
|---|---|---|
| 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. |
| Denosumab Products (Prolia, Jubbonti, Stoboclo, Conexxence, Bildyos, Ospomyv, Bosaya, Enoby) Non-oncology | Not recorded | Prior auth requiredInferred from policy title |
| 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. |
|---|
| 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. |
|---|
| Denosumab Products (Prolia, Jubbonti, Stoboclo) Non-oncologyEffective 10/01/2025 - 10/31/2025 | Oct 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Denosumab Products (Prolia, Jubbonti) non-oncologyEffective 09/01/2025 - 09/30/2025 | Sep 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of Q5136 |
|---|---|---|
| Denosumab | Jul 1, 2026 | Covered |
| Oncology Medication Clinical Coverage | Apr 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5136 |
|---|---|---|
| Denosumab | Jul 1, 2026 | Covered |
| Oncology Medication Clinical Coverage | Apr 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5136 |
|---|---|---|
| Denosumab | Jul 1, 2026 | Covered |
| Oncology Medication Clinical Coverage | Apr 1, 2026 | Covered |
| Policy | Effective | Status of Q5136 |
|---|---|---|
| Denosumab and Biosimilars for Non-Oncologic Indications | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5136 |
|---|---|---|
| Denosumab and Biosimilars for Non-Oncologic Indications | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5136 |
|---|---|---|
| Denosumab and Biosimilars for Non-Oncologic Indications | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5136 |
|---|---|---|
| Denosumab and Biosimilars for Non-Oncologic Indications | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5136 |
|---|---|---|
| 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 Q5136 |
|---|---|---|
| Cigna MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of Q5136 |
|---|---|---|
| Q3 - 2026 Jefferson Health Plans MedOnc Master Drug List | Not recorded | Prior auth required |
| Policy | Effective | Status of Q5136 |
|---|---|---|
| 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. |