Summary & Overview
HCPCS Level II J1437: Injection, Ferric Derisomaltose, 10 mg
HCPCS Level II code J1437 denotes a 10 mg injection of ferric derisomaltose, an intravenous iron formulation used for patients with iron deficiency who require parenteral therapy. Nationally, accurate reporting of this HCPCS Level II code matters for clinical billing, inventory management, and monitoring utilization of IV iron therapies across outpatient infusion settings.
The analysis covers major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of billing practices, payer coverage considerations, and clinical context for use of ferric derisomaltose. The publication provides benchmarks where available, notes on coding and billing patterns, and summaries of relevant policy updates affecting reimbursement and prior authorization processes.
This resource is designed for revenue cycle professionals, infusion center administrators, and clinicians involved in parenteral iron therapy. It clarifies the service setting expectations for J1437, highlights common payer coverage landscapes, and summarizes what to expect in claims submission and payer interactions. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J1437 represents an injection of ferric derisomaltose, 10 mg. This code reports administration of an intravenous iron compound used to treat iron deficiency when parenteral therapy is indicated. The service type is intravenous medication administration, and the typical site of service is an outpatient infusion center, hospital outpatient department, or physician office capable of IV infusions.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with iron-deficiency anemia who has failed or cannot tolerate oral iron therapy and is scheduled to receive an intravenous iron infusion of ferric derisomaltose (J1437). The patient is evaluated in an outpatient infusion suite or hospital outpatient infusion center. Pre-infusion workflow includes verification of diagnosis, baseline vital signs, informed consent, review of prior reactions to IV iron, and documentation of recent hemoglobin, ferritin, and transferrin saturation results. An IV line is placed, the calculated therapeutic dose is prepared by pharmacy (using J1437 billed per 10 mg increment), and the infusion is administered over the manufacturer-recommended infusion time while monitoring for hypersensitivity or infusion reactions. Post-infusion monitoring includes vital signs, observation for 15–60 minutes per institutional protocol, documentation of any adverse events, and discharge instructions. Typical sites of service are outpatient infusion centers, physician office-based infusion suites, or hospital outpatient departments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug or biological amount discarded/not administered to any patient | When a portion of the ferric derisomaltose vial is wasted and payer requires reporting of discarded drug units. |