Ferric Derisomaltose Injection, for Intravenous Use (Monoferric™) HCPCS Code J1437: Billing Guidelines

Tuesday, January 5, 2021

Effective with date of service Oct. 2, 2020, the Medicaid and NC Health Choice programs cover ferric derisomaltose injection, for intravenous use (Monoferric™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J1437 - Injection, ferric derisomaltose, 10 mg.

Strength/Package Size(s): Injection: 1,000 mg iron /10 mL (100 mg/mL) single-dose vial

Indicated for the treatment of iron deficiency anemia in adult patients:

  • Who have intolerance to oral iron or have had unsatisfactory response to oral iron
  • Who have non-hemodialysis dependent chronic kidney disease

Recommended Dose (see full prescribing information for further detail): 

  • For patients weighing 50 kg or more: Administer 1,000 mg of Monoferric™ as an intravenous infusion.
  • For patients weighing less than 50 kg: Administer Monoferric™ as 20 mg/kg actual body weight as an intravenous infusion.

For Medicaid and NC Health Choice Billing

  • The ICD-10-CM diagnosis code(s) required for billing is/are:  
    • D50.0 - Iron deficiency anemia secondary to blood loss (chronic); 
    • D50.8 - Other iron deficiency anemias; 
    • D50.9 - Iron deficiency anemia, unspecified; 
    • D63.0 - Anemia in neoplastic disease; 
    • D63.1 - Anemia in chronic kidney disease; 
    • D63.8 - Anemia in other chronic diseases classified elsewhere;
    • D64.81 - Antineoplastic chemotherapy-induced anemia
  • Providers must bill with HCPCS code: J1437 
  • One Medicaid and NC Health Choice unit of coverage is: 10 mg 
  • The maximum reimbursement rate per unit is: $26.61
  • Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs is/are: 73594-9310-01 
  • 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 PADP, refer to the PADP Clinical Coverage Policy 1B, Attachment A, H.7 on Medicaid's website
  • Providers shall bill their usual and customary charge for non-340B drugs
  • PADP reimburses for drugs billed for Medicaid and Health Choice beneficiaries by 340B 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 340B purchasing agreement by appending the “UD” modifier on the drug detail.
  • The fee schedule for the PADP is available on Medicaid's PADP web page

Contact

NCTracks Contact Center: 800-688-6696