Iron Sucrose (Venofer) HCPCS code J1756: Billing Guidelines

<p style="margin-bottom: 0pt;">Effective with the date of service of April 30, 2018, the North Carolina Medicaid and Health Choice programs will be terminating Clinical Policy 1B-3, Intravenous Iron Therapy, within the Physician Drug Program.</p>

Author: CSRA

Effective with the date of service of April 30, 2018, the North Carolina Medicaid and Health Choice (NCHC) programs will be terminating Clinical Policy 1B-3, Intravenous Iron Therapy, within the Physician Drug Program (PDP). Requirements, indications, and all other information of the policy are indicated below. From the perspective of the providers, all things associated with the process of submitting claims regarding the IV Iron agents will remain unchanged.

Please see prescribing information for details.

Below is information regarding iron sucrose.

Medicaid and NCHC shall cover iron sucrose for the following FDA-approved indications

  1. Adult patients with iron deficiency anemia in hemodialysis-dependent chronic kidney disease (HDD-CKD) with epoetin therapy
  2. Adult patients with iron deficiency anemia in peritoneal dialysis-dependent chronic kidney disease (PDD-CKD) with epoetin therapy; adult patients with iron deficiency anemia in non-dialysis dependent chronic kidney disease (NDD-CKD) with or without epoetin therapy
  3. Pediatric patients (2 years of age and older) as iron maintenance treatment in hemodialysis-dependent chronic kidney disease (HDD-CKD), and
  4. Pediatric patients (2 years of age and older) with iron deficiency anemia in non-dialysis dependent chronic kidney disease (NDD-CKD) or peritoneal dialysis-dependent chronic kidney disease (PDD-CKD) who are on erythropoietin.

Medicaid and NCHC shall cover iron sucrose for the following off-label indications

  1. Iron deficiency anemia from cancer and cancer chemotherapy
  2. Iron deficiency anemia of excessive uterine blood loss or pregnancy
  3. Iron deficiency with comorbid heart failure
  4. Iron repletion for autologous blood transfusions
  5. Gastrointestinal (gi) blood loss with iron deficiency
  6. Disorders of iron metabolism
  7. Iron deficiency where oral treatment is ineffective or infeasible
  8. Gastrointestinal (gi) blood loss with iron deficiency (such as gastric bypass surgery, celiac disease, inflammatory bowel disease
  9. Iron deficiency due to intravascular hemolysis (such as paroxysmal nocturnal hemoglobinuria, valvular heart disease and malfunctioning prosthetic valves), and<
  10. 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:

Primary Diagnosis

D50.0

D50.1

  D50.8

D50.9

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

D63.0

D64.81

Secondary Diagnosis

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

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

  • ICD-10 codes for iron deficiency anemias of excessive uterine blood loss or pregnancy are:

Primary Diagnosis

D50.0

D50.1

D50.8

D50.9

O46.0

Secondary Diagnosis

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

Z34.83

Z34.90

Z34.91

Z34.92

Z34.93
  • ICD-10 codes for anemia in chronic kidney disease are:

Primary Diagnosis

D63.1

Secondary Diagnosis

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:

Z52.000

Z52.008

Z52.010

Z52.018

Z52.090

Z52.098

  • ICD-10 codes for gastrointestinal (GI) complications with iron deficiency are:

Primary Diagnosis

D50.0

D50.1

D50.8

D50.9

K92.2

Secondary Diagnosis

D62

K90.0

K91.1

K91.2

K94.21

K95.09

K95.89

  • ICD-10 codes for iron deficiency with comorbid heart failure are:

Primary Diagnosis

D50.0

D50.1

D50.8

D50.9

Secondary Diagnosis

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

D50.8

D51.0

D61.1

  • Only one electrical stimulation or electromyography code may be reported for each injection site. The following procedure codes for electrical stimulation or EMG guidance may be billed if appropriate. (List separately in addition to a code for a primary procedure). CPT Code(s): 95873, 95874.
  • Providers must bill with HCPCS code J0587: Injection, rimabotulinumtoxinB (Myobloc
  • One Medicaid unit of coverage is 100 units. NCHC bills according to Medicaid units.
  • The maximum reimbursement rate per unit is $8.31.
  • Providers must bill 11-digit National Drug Codes (NDCs) and appropriate NDC units. The NDCs are 10454071010, 10454071110 and 10454071210.
  • 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

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