Author: CSRA
See prescribing information for details.
Below is information regarding Ferrlecit.
Medicaid and NCHC cover sodium ferric gluconate complex in sucrose for beneficiaries aged 6 years and older for the following FDA approved indications:
- Iron deficiency anemia in beneficiaries undergoing chronic hemodialysis (HDD-CKD) who are receiving epoetin therapy
- Medicaid and NCHC covers sodium ferric gluconate complex in sucrose for beneficiaries aged 6 years and older for the following off-label indications:
- Iron deficiency anemia in beneficiaries with chronic kidney disease who are on peritoneal dialysis (pdd-ckd)
- Iron deficiency anemia in beneficiaries who are non-dialysis dependent with chronic kidney disease (ndd-ckd)
- Iron deficiency anemia of excessive uterine blood loss or pregnancy
- Iron deficiency anemia in beneficiaries with cancer or who have chemotherapy- associated anemia
- Iron deficiency anemia with comorbid heart failure
- Iron repletion for autologous blood transfusion;
- Gastrointestinal (gi) blood loss with iron deficiency (such as gastric bypass surgery, celiac disease, inflammatory bowel disease)
- Disorders of iron metabolism
- Iron deficiency where oral treatment is ineffective or infeasible
- Iron deficiency due to intravascular hemolysis (such as paroxysmal nocturnal hemoglobinuria, valvular heart disease and malfunctioning prosthetic valves), and
- Iron deficiency due to achlorhydria (including pernicious anemia or medication induced).
For Medicaid and NCHC Billing
- ICD-10 codes for iron deficiency anemias where oral treatment is not suitable are:
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Primary Diagnosis |
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D50.0
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D50.1
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D50.8 D50.9 |
|
Secondary Diagnosis |
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|
K50.00 K50.011 K50.012 K50.013 K50.014 K50.018 K50.019 K50.10 K50.111 K50.112 K50.113 K50.114 K50.118 K50.119 K50.80 K50.811 K50.812 K50.813 K50.814 K50.818 K50.819 K50.90 K50.911 K50.912 K50.913 K50.914 K50.918 K50.919 K51.00 K51.011 |
K51.012 K51.013 K51.014 K51.018 K51.019 K51.20 K51.211 K51.212 K51.213 K51.214 K51.218 K51.219 K51.30 K51.311 K51.312 K51.313 K51.314 K51.318 K51.319 K51.40 K51.411 K51.412 K51.413 K51.414 K51.418 K51.419 K51.50 K51.511 K51.512 K51.513 |
K51.514 K51.518 K51.519 K51.80 K51.811 K51.812 K51.813 K51.814 K51.818 K51.819 K51.90 K51.911 K51.912 K51.913 K51.914 K51.918 K51.919 K90.0 K90.1 K90.2 K90.3 K90.4 K90.89 K90.9 K91.2 Z87.19 |
- ICD-10 codes for disorders of iron metabolism are:
|
E83.10 E83.110 |
E83.111 E83.118 |
E83.119 E83.19 |
- ICD-10 codes for anemia in neoplastic disease or antineoplastic chemotherapy induced anemia are:
|
Primary Diagnosis |
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|
D63.0 |
D64.81 |
|
|
Secondary Diagnosis |
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C00.0 C00.1 C00.2 C00.3 C00.4 C00.5 C00.6 C00.8 C00.9 C01 C02.0 C02.1 C02.2 C02.3 C02.4 C02.8 C02.9 C03.0 C03.1 C03.9 C04.0 C04.1 C04.8 C04.9 C05.0 C05.1 C05.2 C05.8 C05.9 C06.0 C06.1 C06.2 C06.80 C06.89 C06.9 C07 C08.0 C08.1 C08.9 C09.0 C09.1 C09.8 C09.9 C10.0 C10.1 C10.2 C10.3 C10.4 C10.8 C10.9 C11.0 C11.1 C11.2 C11.3 C11.8 C11.9 C12 C13.0 C13.1 C13.2 C13.8 C13.9 C14.0 C14.2 C14.8 C15.3 C15.4 C15.5 C15.8 C15.9 C16.0 C16.1 C16.2 C16.3 C16.4 C16.5 C16.6 C16.8 C16.9 C17.0 C17.1 C17.2 C17.3 C17.8 C17.9 C18.0 C18.1 C18.2 C18.3 C18.4 C18.5 C18.6 C18.7 C18.8 C18.9 C19 C20 C21.0 C21.1 C21.2 C21.8 C22.0 C22.1 C22.2 C22.3 C22.4 C22.7 C22.8 C22.9 C23 C24.0 C24.1 C24.8 C24.9 C25.0 C25.1 C25.2 C25.3 C25.4 C25.7 C25.8 C25.9 C26.0 C26.1 C26.9 C30.0 C30.1 C31.0 C31.1 C31.2 C31.3 C31.8 C31.9 C32.0 C32.1 C32.2 C32.3 C32.8 C32.9 C33 C34.00 C34.01 C34.02 C34.10 C34.11 C34.12 C34.2 C34.30 C34.31 C34.32 C34.80 C34.81 C34.82 C34.90 C34.91 C34.92 C37 C38.0 C38.1 C38.2 C38.3 C38.4 C38.8 C39.0 C39.9 C40.00 C40.01 C40.02 C40.10 C40.11 C40.12 C40.20 C40.21 C40.22 C40.30 C40.31 C40.32 C40.80 C40.81 C40.82 C40.90 C40.91 C40.92 C41.0 C41.1 C41.2 C41.3 C41.4 C41.9 C43.0 C43.10 C43.11 C43.12 C43.20 C43.21 C43.22 C43.30 C43.31 C43.39 C43.4 C43.51 C43.52 C43.59 C43.60 C43.61 C43.62 C43.70 C43.71 C43.72 C43.8 C43.9 C44.00 C44.01 C44.02 C44.09 C44.101 C44.102 C44.109 C44.111 C44.112 C44.119 C44.121 C44.122 C44.129 C44.191 C44.192 C44.199 C44.201 C44.202 C44.209 C44.211 C44.212 C44.219 C44.221 C44.222 C44.229 C44.291 C44.292 C44.299 C44.300 C44.301 C44.309 C44.310 C44.311 C44.319 C44.320 C44.321 C44.329 C44.390 C44.391 C44.399 C44.40 C44.41 C44.42 C44.49 C44.500 C44.501 C44.509 C44.510 C44.511 C44.519 C44.520 C44.521 C44.529 C44.590 C44.591 C44.599 C44.601 C44.602 C44.609 C44.611 C44.612 C44.619 C44.621 C44.622 C44.629 C44.691 C44.692 C44.699 C44.701 C44.702 C44.709 C44.711 C44.712 C44.719 C44.721 C44.722 C44.729 C44.791 C44.792 C44.799 C44.80 C44.81 C44.82 C44.89 C44.90 C44.91 C44.92 C44.99 C45.0 C45.1 C45.2 C45.7 C45.9 C46.0 C46.1 C46.2 C46.3 C46.4 C46.50 C46.51 C46.52 C46.7 C46.9 C47.0 C47.10 C47.11 C47.12 C47.20 C47.21 C47.22 C47.3 C47.4 C47.5 C47.6 C47.8 C47.9 C48.0 C48.1 C48.2 C48.8 C49.0 C49.10 C49.11 C49.12 C49.20 C49.21 C49.22 C49.3 C49.4 C49.5 C49.6 C49.8 C49.9 C4A.0 C4A.10 C4A.11 C4A.12 C4A.20 C4A.21 C4A.22 C4A.30 C4A.31 C4A.39 C4A.4 C4A.51 C4A.52 C4A.59 C4A.60 C4A.61 C4A.62 C4A.70 C4A.71 C4A.72 C4A.8 C4A.9 C50.011 C50.012 C50.019 C50.021 C50.022 C50.029 C50.111 C50.112 C50.119 C50.121 C50.122 C50.129 C50.211 C50.212 C50.219 C50.221 C50.222 C50.229 C50.311 C50.312 C50.319 C50.321 C50.322 C50.329 C50.411 C50.412 C50.419 C50.421 C50.422 C50.429 C50.511 C50.512 C50.519 C50.521 C50.522 C50.529 C50.611 C50.612 C50.619 C50.621 C50.622 C50.629 C50.811 C50.812 C50.819 C50.821 C50.822 C50.829 C50.911 C50.912 C50.919 C50.921 C50.922 C50.929 C51.0 C51.1 C51.2 C51.8 C51.9 C52 C53.0 C53.1 C53.8 C53.9 C54.0 C54.1 C54.2 C54.3 C54.8 C54.9 C55 C56.1 C56.2 C56.9 C57.00 C57.01 C57.02 C57.10 C57.11 C57.12 C57.20 C57.21 C57.22 C57.3 C57.4 C57.7 C57.8 C57.9 C58 C60.0 C60.1 C60.2 C60.8 C60.9 C61 C62.00 C62.01 C62.02 C62.10 C62.11 C62.12 C62.90 C62.91 C62.92 C63.00 C63.01 C63.02 C63.10 C63.11 C63.12 C63.2 C63.7 C63.8 C63.9 C64.1 C64.2 C64.9 C65.1 C65.2 C65.9 C66.1 C66.2 C66.9 C67.0 C67.1 C67.2 C67.3 C67.4 C67.5 C67.6 C67.7 C67.8 C67.9 C68.0 C68.1 C68.8 C68.9 C69.00 C69.01 C69.02 C69.10 C69.11 C69.12 C69.20 C69.21 C69.22 C69.30 C69.31 C69.32 C69.40 C69.41 C69.42 C69.50 C69.51 C69.52 C69.60 C69.61 C69.62 C69.81 C69.82 C69.90 C69.91 C69.92 C70.0 C70.1 C70.9 C71.0 C71.1 C71.2 C71.3 C71.4 C71.5 C71.6 C71.7 C71.8 C71.9 C72.0 C72.1 |
C72.20 C72.21 C72.22 C72.30 C72.31 C72.32 C72.40 C72.41 C72.42 C72.50 C72.59 C72.9 C73 C74.00 C74.01 C74.02 C74.10 C74.11 C74.12 C74.90 C74.91 C74.92 C75.0 C75.1 C75.2 C75.3 C75.4 C75.5 C75.8 C75.9 C76.0 C76.1 C76.2 C76.3 C76.40 C76.41 C76.42 C76.50 C76.51 C76.52 C76.8 C77.0 C77.1 C77.2 C77.3 C77.4 C77.5 C77.8 C77.9 C78.00 C78.01 C78.02 C78.1 C78.2 C78.30 C78.39 C78.4 C78.5 C78.6 C78.7 C78.80 C78.89 C79.00 C79.01 C79.02 C79.10 C79.11 C79.19 C79.2 C79.31 C79.32 C79.40 C79.49 C79.51 C79.52 C79.60 C79.61 C79.62 C79.70 C79.71 C79.72 C79.81 C79.82 C79.89 C79.9 C7A.00 C7A.010 C7A.011 C7A.012 C7A.019 C7A.020 C7A.021 C7A.022 C7A.023 C7A.024 C7A.025 C7A.026 C7A.029 C7A.090 C7A.091 C7A.092 C7A.093 C7A.094 C7A.095 C7A.096 C7A.098 C7A.1 C7A.8 C7B.00 C7B.01 C7B.02 C7B.03 C7B.04 C7B.09 C7B.1 C7B.8 C80.0 C80.1 C80.2 C81.00 C81.01 C81.02 C81.03 C81.04 C81.05 C81.06 C81.07 C81.08 C81.09 C81.10 C81.11 C81.12 C81.13 C81.14 C81.15 C81.16 C81.17 C81.18 C81.19 C81.20 C81.21 C81.22 C81.23 C81.24 C81.25 C81.26 C81.27 C81.28 C81.29 C81.30 C81.31 C81.32 C81.33 C81.34 C81.35 C81.36 C81.37 C81.38 C81.39 C81.40 C81.41 C81.42 C81.43 C81.44 C81.45 C81.46 C81.47 C81.48 C81.49 C81.70 C81.71 C81.72 C81.73 C81.74 C81.75 C81.76 C81.77 C81.78 C81.79 C81.90 C81.91 C81.92 C81.93 C81.94 C81.95 C81.96 C81.97 C81.98 C81.99 C82.00 C82.01 C82.02 C82.03 C82.04 C82.05 C82.06 C82.07 C82.08 C82.09 C82.10 C82.11 C82.12 C82.13 C82.14 C82.15 C82.16 C82.17 C82.18 C82.19 C82.20 C82.21 C82.22 C82.23 C82.24 C82.25 C82.26 C82.27 C82.28 C82.29 C82.30 C82.31 C82.32 C82.33 C82.34 C82.35 C82.36 C82.37 C82.38 C82.39 C82.40 C82.41 C82.42 C82.43 C82.44 C82.45 C82.46 C82.47 C82.48 C82.49 C82.50 C82.51 C82.52 C82.53 C82.54 C82.55 C82.56 C82.57 C82.58 C82.59 C82.60 C82.61 C82.62 C82.63 C82.64 C82.65 C82.66 C82.67 C82.68 C82.69 C82.80 C82.81 C82.82 C82.83 C82.84 C82.85 C82.86 C82.87 C82.88 C82.89 C82.90 C82.91 C82.92 C82.93 C82.94 C82.95 C82.96 C82.97 C82.98 C82.99 C83.00 C83.01 C83.02 C83.03 C83.04 C83.05 C83.06 C83.07 C83.08 C83.09 C83.10 C83.11 C83.12 C83.13 C83.14 C83.15 C83.16 C83.17 C83.18 C83.19 C83.30 C83.31 C83.32 C83.33 C83.34 C83.35 C83.36 C83.37 C83.38 C83.39 C83.50 C83.51 C83.52 C83.53 C83.54 C83.55 C83.56 C83.57 C83.58 C83.59 C83.70 C83.71 C83.72 C83.73 C83.74 C83.75 C83.76 C83.77 C83.78 C83.79 C83.80 C83.81 C83.82 C83.83 C83.84 C83.85 C83.86 C83.87 C83.88 C83.89 C83.90 C83.91 C83.92 C83.93 C83.94 C83.95 C83.96 C83.97 C83.98 C83.99 C84.00 C84.01 C84.02 C84.03 C84.04 C84.05 C84.06 C84.07 C84.08 C84.09 C84.10 C84.11 C84.12 C84.13 C84.14 C84.15 C84.16 C84.17 C84.18 C84.19 C84.40 C84.41 C84.42 C84.43 C84.44 C84.45 C84.46 C84.47 C84.48 C84.49 C84.60 C84.61 C84.62 C84.63 C84.64 C84.65 C84.66 C84.67 C84.68 C84.69 C84.70 C84.71 C84.72 C84.73 C84.74 C84.75 C84.76 C84.77 C84.78 C84.79 C84.90 C84.91 C84.92 C84.93 C84.94 C84.95 C84.96 C84.97 C84.98 C84.99 C84.A0 C84.A1 C84.A2 C84.A3 C84.A4 C84.A5 C84.A6 C84.A7 C84.A8 C84.A9 C84.Z0 C84.Z1 C84.Z2 C84.Z3 C84.Z4 C84.Z5 C84.Z6 C84.Z7 C84.Z8 C84.Z9 C85.10 C85.11 C85.12 C85.13 C85.14 C85.15 C85.16 C85.17 C85.18 C85.19 C85.20 C85.21 C85.22 C85.23 C85.24 C85.25 C85.26 C85.27 C85.28 C85.29 C85.80 C85.81 C85.82 C85.83 C85.84 C85.85 C85.86 C85.87 C85.88 C85.89 C85.90 C85.91 C85.92 C85.93 C85.94 C85.95 C85.96 C85.97 C85.98 C85.99 C86.0 C86.1 C86.2 C86.3 C86.4 C86.5 C86.6 C88.0 C88.2 C88.3 C88.4 C88.8 C88.9 C90.00 C90.01 C90.02 C90.10 C90.11 C90.12 C90.20 C90.21 C90.22 C90.30 C90.31 C90.32 C91.00 C91.01 C91.02 C91.10 C91.11 C91.12 C91.30 C91.31 C91.32 C91.40 C91.41 C91.42 C91.50 C91.51 C91.52 C91.60 C91.61 C91.62 C91.90 C91.91 C91.92 C91.A0 C91.A1 C91.A2 C91.Z0 C91.Z1 C91.Z2 C92.00 C92.01 C92.02 C92.10 C92.11 C92.12 C92.20 C92.21 C92.22 C92.30 C92.31 C92.32 C92.40 C92.41 C92.42 C92.50 C92.51 C92.52 C92.60 C92.61 C92.62 C92.90
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C92.91 C92.92 C92.A0 C92.A1 C92.A2 C92.Z0 C92.Z1 C92.Z2 C93.00 C93.01 C93.02 C93.10 C93.11 C93.12 C93.30 C93.31 C93.32 C93.90 C93.91 C93.92 C93.Z0 C93.Z1 C93.Z2 C94.00 C94.01 C94.02 C94.20 C94.21 C94.22 C94.30 C94.31 C94.32 C94.4 C94.41 C94.42 C94.80 C94.81 C94.82 C95.00 C95.01 C95.02 C95.10 C95.11 C95.12 C95.90 C95.91 C95.92 C96.0 C96.2 C96.4 C96.5 C96.6 C96.A C96.Z C96.9 D00.00 D00.01 D00.02 D00.03 D00.04 D00.05 D00.06 D00.07 D00.08 D00.1 D00.2 D01.0 D01.1 D01.2 D01.3 D01.40 D01.49 D01.5 D01.7 D01.9 D02.0 D02.1 D02.20 D02.21 D02.22 D02.3 D02.4 D03.0 D03.10 D03.11 D03.12 D03.20 D03.21 D03.22 D03.30 D03.39 D03.4 D03.51 D03.52 D03.59 D03.60 D03.61 D03.62 D03.70 D03.71 D03.72 D03.8 D03.9 D04.0 D04.10 D04.11 D04.12 D04.20 D04.21 D04.22 D04.30 D04.39 D04.4 D04.5 D04.60 D04.61 D04.62 D04.70 D04.71 D04.72 D04.8 D04.9 D05.00 D05.01 D05.02 D05.10 D05.11 D05.12 D05.80 D05.81 D05.82 D05.90 D05.91 D05.92 D06.0 D06.1 D06.7 D06.9 D07.0 D07.1 D07.2 D07.30 D07.39 D07.4 D07.5 D07.60 D07.61 D07.69 D09.0 D09.10 D09.19 D09.20 D09.21 D09.22 D09.3 D09.8 D09.9 D10.0 D10.1 D10.2 D10.30 D10.39 D10.4 D10.5 D10.6 D10.7 D10.9 D11.0 D11.7 D11.9 D12.0 D12.1 D12.2 D12.3 D12.4 D12.5 D12.6 D12.7 D12.8 D12.9 D13.0 D13.1 D13.2 D13.30 D13.39 D13.4 D13.5 D13.6 D13.7 D13.9 D14.0 D14.1 D14.2 D14.30 D14.31 D14.32 D14.4 D15.0 D15.1 D15.2 D15.7 D15.9 D16.00 D16.01 D16.02 D16.10 D16.11 D16.12 D16.20 D16.21 D16.22 D16.30 D16.31 D16.32 D16.4 D16.5 D16.6 D16.7 D16.8 D16.9 D17.0 D17.1 D17.20 D17.21 D17.22 D17.23 D17.24 D17.30 D17.39 D17.4 D17.5 D17.6 D17.71 D17.72 D17.79 D17.9 D18.00 D18.01 D18.02 D18.03 D18.09 D18.1 D19.0 D19.1 D19.7 D19.9 D20.0 D20.1 D21.0 D21.10 D21.11 D21.12 D21.20 D21.21 D21.22 D21.3 D21.4 D21.5 D21.6 D21.9 D22.0 D22.10 D22.11 D22.12 D22.20 D22.21 D22.22 D22.30 D22.39 D22.4 D22.5 D22.60 D22.61 D22.62 D22.70 D22.71 D22.72 D22.9 D23.0 D23.10 D23.11 D23.12 D23.20 D23.21 D23.22 D23.30 D23.39 D23.4 D23.5 D23.60 D23.61 D23.62 D23.70 D23.71 D23.72 D23.9 D24.1 D24.2 D24.9 D25.0 D25.1 D25.2 D25.9 D26.0 D26.1 D26.7 D26.9 D27.0 D27.1 D27.9 D28.0 D28.1 D28.2 D28.7 D28.9 D29.0 D29.1 D29.20 D29.21 D29.22 D29.30 D29.31 D29.32 D29.4 D29.8 D29.9 D30.00 D30.01 D30.02 D30.10 D30.11 D30.12 D30.20 D30.21 D30.22 D30.3 D30.4 D30.8 D30.9 D31.00 D31.01 D31.02 D31.10 D31.11 D31.12 D31.20 D31.21 D31.22 D31.30 D31.31 D31.32 D31.40 D31.41 D31.42 D31.50 D31.51 D31.52 D31.60 D31.61 D31.62 D31.90 D31.91 D31.92 D32.0 D32.1 D32.9 D33.0 D33.1 D33.2 D33.3 D33.4 D33.7 D33.9 D34 D35.00 D35.01 D35.02 D35.1 D35.2 D35.3 D35.4 D35.5 D35.6 D35.7 D35.9 D36.0 D36.10 D36.11 D36.12 D36.13 D36.14 D36.15 D36.16 D36.17 D36.7 D36.9 D37.01 D37.02 D37.030 D37.031 D37.032 D37.039 D37.04 D37.05 D37.09 D37.1 D37.2 D37.3 D37.4 D37.5 D37.6 D37.8 D37.9 D38.0 D38.1 D38.2 D38.3 D38.4 D38.5 D38.6 D39.0 D39.10 D39.11 D39.12 D39.2 D39.8 D39.9 D3A.00 D3A.010 D3A.011 D3A.012 D3A.019 D3A.020 D3A.021 D3A.022 D3A.023 D3A.024 D3A.025 D3A.026 D3A.029 D3A.090 D3A.091 D3A.092 D3A.093 D3A.094 D3A.095 D3A.096 D3A.098 D3A.8 D40.0 D40.10 D40.11 D40.12 D40.8 D40.9 D41.00 D41.01 D41.02 D41.10 D41.11 D41.12 D41.20 D41.21 D41.22 D41.3 D41.4 D41.8 D41.9 D42.0 D42.1 D42.9 D43.0 D43.1 D43.2 D43.3 D43.4 D43.8 D43.9 D44.0 D44.10 D44.11 D44.12 D44.2 D44.3 D44.4 D44.5 D44.6 D44.7 D44.9 D45 D46.0 D46.1 D46.20 D46.21 D46.22 D46.A D46.B D46.C D46.4 D46.Z D46.9 D47.0 D47.1 D47.2 D47.3 D47.4 D47.9 D47.Z1 D47.Z9 D48.0 D48.1 D48.2 D48.3 D48.4 D48.5 D48.60 D48.61 D48.62 D48.7 D48.9 D49.0 D49.1 D49.2 D49.3 D49.4 D49.5 D49.7 D49.81 D49.89 D49.9 K31.7 K63.5 Q85.00 Q85.01 Q85.02 Q85.03 Q85.09
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- ICD-10 codes for iron deficiency anemias of excessive uterine blood loss or pregnancy are:
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Primary Diagnosis |
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D50.0 D50.1 |
D50.8 D50.9 |
O46.0 |
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Secondary Diagnosis |
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N92.0 N92.1 N92.3 N92.5 N92.6 N92.2 N92.4 N95.0 |
Z34.00 Z34.01 Z34.02 Z34.03 Z34.80 Z34.81 Z34.82
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Z34.83 Z34.90 Z34.91 Z34.92 Z34.93 |
- ICD-10 codes for anemia in chronic kidney disease are:
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Primary Diagnosis |
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D63.1 |
|
|
|
Secondary Diagnosis |
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N18.1 N18.2 N18.3 |
N18.4 N18.5 |
N18.6 N18.9 |
- ICD-10 codes for iron repletion for autologous blood transfusions are:
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Z52.000 Z52.008 |
Z52.010 Z52.018
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Z52.090 Z52.098 |
- ICD-10 codes for gastrointestinal (GI) complications with iron deficiency are:
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Primary Diagnosis |
||
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D50.0 D50.1 |
D50.8 D50.9 |
K92.2
|
|
Secondary Diagnosis |
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D62 |
K90.0 K91.1 K91.2 |
K94.21 K95.09 K95.89 |
- ICD-10 codes for iron deficiency with comorbid heart failure are:
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Primary Diagnosis |
||
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D50.0 |
D50.1 |
D50.8 D50.9 |
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Secondary Diagnosis |
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I42.0 I42.1 I42.2 I42.3 I42.4 I42.5 I42.6 I42.7 |
I42.8 I42.9 I50.1 I50.20 I50.21 I50.22 I50.23 I50.30 |
I50.31 I50.32 I50.33 I50.40 I50.41 I50.42 I50.43 I50.9 |
- ICD-10 codes for iron deficiency due to achlorhydria or intravascular hemolysis are:
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D50.8 |
D51.0 |
D61.1 |
- Providers must bill with HCPCS code J1750: Iron Dextran, Injection.
- One Medicaid and NCHC unit of coverage is 50 mg.
- The maximum reimbursement rate per unit is $11.25.
- Providers must bill 11-digit National Drug Codes (NDCs) and appropriate NDC units. The NDCs are 52544093102 and 52544093107.
- The NDC units should be reported as “UN1.”
- For additional information, refer to the January 2012, Special Bulletin, National Drug Code Implementation Update.
- For additional information regarding NDC claim requirements related to the PDP, refer to the PDP Clinical Coverage Policy No. 1B, Physicians Drug Program, Attachment A, H.7 on Medicaid’s website.
- Providers shall bill their usual and customary charge for non-340-B drugs.
- PDP reimburses for drugs billed for Medicaid and NCHC beneficiaries by 340-B participating providers who have registered with the Office of Pharmacy Affairs (OPA). Providers billing for 340B drugs shall bill the cost that is reflective of their acquisition cost. Providers shall indicate that a drug was purchased under a 340-B purchasing agreement by appending the “UD” modifier on the drug detail.
- The fee schedule for the PDP is available on the North Carolina Medicaid PDP web page.
CSRA, 1-800-688-6696