## **What is HCPCS code Q0138?**
HCPCS code Q0138 is used for billing "Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-ESRD use)." This code specifically covers ferumoxytol injections administered to patients with iron deficiency anemia who do not have end-stage renal disease (ESRD). The code Q0138 is designated for non-ESRD use, distinguishing it from treatments provided to dialysis-dependent patients.
Ferumoxytol, originally developed by AMAG Pharmaceuticals, is an FDA-approved intravenous iron therapy that provides rapid iron replacement for patients experiencing iron deficiency (Spinowitz et al., 2008). Unlike other iron compounds such as iron sucrose injection, sodium ferric gluconate complex, or iron dextran, ferumoxytol offers unique pharmacokinetic properties that allow for higher doses with fewer infusion sessions.
The injection of ferumoxytol for treatment is particularly beneficial for patients with chronic kidney disease, including those with non-dialysis-dependent (NDD CKD), hemodialysis-dependent (HDD CKD), and peritoneal dialysis-dependent (PDD CKD) conditions. However, Q0138 specifically applies to non-ESRD patients, making it relevant for:
- Patients with chronic diseases classified under various conditions affecting iron metabolism
- Individuals with ulcerative colitis and associated iron deficiency
- Non-dialysis-dependent chronic kidney disease patients requiring iron supplementation
- Patients with other chronic diseases that impair iron absorption or increase iron losses
## **Documentation requirements**
Documentation must clearly establish the presence of iron deficiency anemia through appropriate diagnostic tests. Laboratory values should include hemoglobin levels, serum ferritin, transferrin saturation, and other relevant iron metabolism indicators. The absence of adequate response to oral iron therapy or contraindications to oral iron should be documented in the patient's medical record.
Prescribing information must align with FDA-approved indications for ferumoxytol use. The documentation should specify the patient's diagnosis using appropriate ICD-10 codes and demonstrate that the treatment meets medical necessity criteria established for Medicare coverage and other payers.
## **Billing requirements**
Medicare coverage for ferumoxytol under Q0138 requires adherence to specific coverage criteria. The Centers for Medicare & Medicaid Services (CMS) has established guidelines for when intravenous iron therapy is considered medically necessary for non-ESRD patients. Providers should verify coverage policies with local Medicare Administrative Contractors, as policies may vary by region.
When submitting claims for Q0138, providers must ensure accurate dosage reporting. Since the code represents 1 mg of ferumoxytol, the units billed should correspond to the total milligrams administered. For example, a 510 mg dose would be billed as 510 units of Q0138.
The service should be billed with appropriate place of service codes, whether administered in an office, outpatient hospital, or other covered facility. Proper diagnosis codes must support the medical necessity for intravenous iron therapy over alternative treatments.
## **Other relevant codes**
- **J1750**: Injection, iron dextran, 50 mg
- **J1756**: Injection, iron sucrose, 1 mg
- **J2916**: Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg
- **Q0139**: Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (ESRD on dialysis)
## **Reference**
Spinowitz, B. S., Kausz, A. T., Baptista, J., Noble, S. D., Sothinathan, R., Bernardo, M. V., Brenner, L., & Pereira, B. J. (2008). Ferumoxytol for treating iron deficiency anemia in CKD. Journal of the American Society of Nephrology, 19(8), 1599–1605. https://doi.org/10.1681/ASN.2007101156
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