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Most payer criteria require the PA request to document all of the following before approving HCPCS code J3111: A 77080 bone density scan confirms postmenopausal osteoporosis diagnosis with T-score at or below -2.5 (or -1.0 with fragility fracture history, depending on payer) High fracture risk determination by the prescribing physician Failure of or contraindication to prior bisphosphonate therapy, such as zoledronic acid (J3489), or another antiresorptive (payer-specific, but commonly required) Documentation that the patient has not already completed the 12-month maximum treatment duration for romosozumab Prescriber documentation that the patient meets cardiovascular risk thresholds per FDA labeling (romosozumab carries a cardiovascular risk boxed warning) T-score cutoffs and bisphosphonate failure requirements differ across payers

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