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Updated July 1st, 2026

EVENITY J Code: J3111

Injection, romosozumab-aqqg, 1 mg

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Q4 2026 Medicare Payment Limit for J3111, effective October 1, 2026: $12.792 per HCPCS billing unit, up 0.5% from $12.732. From CMS's final file.

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Medicare Payment Limit ?
$12.732
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$12.732
/ HCPCS billing unit · APC 9327
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
4
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Drug & Product Overview

HCPCS Descriptor Injection, romosozumab-aqqg, 1 mg
HCPCS Added Date October 1, 2019
Manufacturer Amgen
Route of Administration Subcutaneous
Generic Status Single-Source; Branded
Dosage Type Single-Dose
Dosage Form Injection, Solution

About EVENITY

Evenity is a medication aligned to the HCPCS J Code: J3111 for billing, pricing, and reimbursement purposes in the United States. This Osteoporosis medication is administered via the subcutaneous route and manufactured by Amgen.

According to CMS Drug Use Information: Romosozumab is used to treat bone loss (osteoporosis) for women after menopause who are at high risk of having broken bones (fractures). It works by increasing bone density and strength. This effect helps to decrease the risk of having a fracture.

Disclaimer: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your healthcare professional.

NDC Code Information

Based on publicly available CMS files. Showing 2 of 4 NDCs — log in for the full crosswalk.

NDC Code Drug Manufacturer Billing Units / Pkg Package Size
55513-0880-02 Evenity Amgen, Inc 210 105 MG / 1.17 ML
55513-0998-02 Evenity Amgen, Inc 210 105 MG / 1.17 ML
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EVENITY
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EVENITY Pricing & Reimbursement

J3111 Private Payer Reimbursement
$12.19 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna

Historical Graphing and Billing Calculator

per HCPCS unit
As of Q3 2026

EVENITY Claims Performance

Claims from Jan 2026 – Aug 2026
Claim Denial Rate 7.55%
Avg. Days to File 4.7days
Avg. Days to Pay 20.8days

Real-world claims performance from FocalPoint, OnPoint Oncology's reimbursement analytics platform, with claims data accrued at the clearing house level.

Explore J3111 claims analytics on FocalPoint →
OnPoint Oncology

EVENITY CPT Administration Codes

The below list of CPT codes is intended for informational purposes only and may not be exhaustive. CPT® codes and descriptions are copyright American Medical Association (AMA). All rights reserved.

CPT Code Description
96372 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intramuscular
JW / JZ modifiers apply

CMS has identified Evenity (J3111) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

EVENITY Medically Unlikely Edits (MUE)

The most billing units of J3111 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 mg.

Practitioner Office & Hospital Outpatient
210 units / day
= 210 mg per day

MAI 3 · Date of Service Edit: Clinical. Per-day limit based on clinical expectations; excess units are denied but may be appealed with documentation of medical necessity. See all MUE limits →

mg Enter a dose to see how many billing units it is and whether it is under the limit.

EVENITY Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.

Osteoporosis in postmenopausal women at high risk for fracture

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Frequently Asked Questions

Is there an available Evenity billing and coding guide?
Billing and coding information for EVENITY can be found through Amgen. Visit Here →
Are there any available Evenity patient assistance programs?
EVENITY patient assistance information can be found through Amgen. Visit Here →
Where can I find Evenity prescribing information?
EVENITY prescribing information can be found at the link below: Visit Here →
Where can I find Evenity side effect information?
Information regarding EVENITY's side effects can be found at MedlinePlus Visit Here →
Does billing EVENITY require JZ/JW wastage modifiers?
CMS has identified EVENITY(J3111) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. See CMS guidelines on use of the JZ and JW wastage modifiers below.

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