HCPCS Code J1437: Injection, Ferric Derisomaltose, 10 mg

Learn about the HCPCS Code J1437 for ferric derisomaltose injection, including its uses, documentation, and billing requirements.

Use Code

## **What is an injection of ferric derisomaltose?** HCPCS code J1437 is the code for injection ferric derisomaltose 10mg, an intravenous iron product to treat iron deficiency anemia in adult patients. This therapy is often prescribed when oral iron therapy is ineffective, not tolerated, or when rapid iron replacement is necessary. According to CMS, this code for injection ferric derisomaltose covers a single dose vial containing ferric derisomaltose 10mg, which is administered via intravenous infusion for the management of absolute iron deficiency, functional iron deficiency, or iron deficiency anemia reoccurs due to chronic kidney disease (CKD), blood loss, neoplastic disease, or myelosuppressive chemotherapy (Centers for Medicare & Medicaid Services, 2020). This intravenous iron therapy can be an essential part of anemia management for patients with an unsatisfactory response to oral iron or those with intolerance to formulations such as iron sucrose, iron dextran, or sodium ferric gluconate complex. By restoring hemoglobin (Hb) levels and improving serum ferritin and transferrin saturation, J1437 for injection ferric derisomaltose helps reduce the impact of anemia in patients with chronic diseases classified under various etiologies, including those receiving hemodialysis. The treatment falls under drugs administered by injection and is maintained by CMS as part of its HCPCS drug listings.

## **Documentation requirements** Documentation for injection ferric derisomaltose 10 mg must support the clinical need for this supplemental iron therapy. Records should include the patient's diagnosis, such as iron deficiency anemia due to chronic kidney disease or other chronic diseases, and confirm that ferric derisomaltose 10 mg was indicated based on laboratory values, including hemoglobin, serum ferritin, and transferrin saturation. Providers should also note any history of unsatisfactory response or intolerance to oral iron therapy, the dosage administered, method of intravenous use, date of service, and the patient's response to treatment. Documentation for injection ferric derisomaltose 10 must verify medical necessity and capture the complete clinical rationale for using this supplemental iron therapy. Records should specify the diagnosis, such as iron deficiency anemia linked to chronic kidney disease or other chronic diseases, and confirm that ferric derisomaltose 10 mg was the appropriate treatment choice. Providers should include relevant lab results, dosage, administration method, date of service, and the patient’s treatment response.

## **J1437 billing requirements** When billing for HCPCS code J1437 (injection ferric derisomaltose 10 mg), providers should: - Bill the correct code: Use J1437 for each 10 mg of ferric derisomaltose administered via intravenous infusion. - Support medical necessity: Ensure claims align with documented diagnoses, such as iron deficiency anemia related to chronic kidney disease or other chronic diseases. - Include accurate dosage and units: Report the total amount administered based on the single-dose vial size and total mg infused. - Document administration details: Record the infusion date, method, and patient’s response. - List other services separately: If given alongside other intravenous iron products or treatments, bill them under their respective HCPCS or CPT codes. - Follow CMS and payer-specific rules: Refer to CMS guidance to prevent claim denials and ensure compliance with drugs administered by injection billing requirements.

## **Other relevant codes** - 96365 – IV infusion administration - J1436 – Injection, ferric carboxymaltose, 10 mg - J1745 – Infliximab, 10 mg

## **Reference** Centers for Medicare & Medicaid Services. (2020). Healthcare Common Procedure Coding System (HCPCS) application summaries and coding decisions: Second quarter, 2020 coding cycle for drug and biological products. U.S. Department of Health & Human Services. https://www.cms.gov/files/document/2020-hcpcs-application-summary-quarter-2-2020-drugs-and-biologicals-updated-07312020.pdf

Frequently asked questions

Ferric derisomaltose is used to treat iron deficiency anemia, especially in adult patients with non-dialysis dependent chronic kidney disease or those who have not responded well or tolerated oral iron supplements, by providing an intravenous iron replacement to improve red blood cell production.

The J code for Monofer, which is the brand name for ferric derisomaltose, is J1437 (Injection, ferric derisomaltose, 10 mg).

The general J codes for iron infusion products vary by specific iron formulation; for example, iron sucrose uses J1756, iron dextran uses J1750, and ferric derisomaltose (Monofer) uses J1437 for billing intravenous iron infusions.