Summary & Overview
HCPCS J2916: Sodium Ferric Gluconate Injection, 12.5 mg
HCPCS Level II code J2916 denotes a 12.5 mg unit of sodium ferric gluconate complex in sucrose injection, an intravenous iron therapy used for patients with iron deficiency when oral therapy is inadequate. This code is nationally relevant because intravenous iron therapies are commonly administered in outpatient infusion settings and impact drug utilization, billing practices, and payer coverage policies across commercial and public payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmark information on utilization and reimbursement patterns, summaries of payer coverage approaches, and clinical context describing typical administration settings and indications. The content highlights billing considerations for infusion administration and unit reporting, and flags areas where payers commonly apply medical necessity criteria or prior authorization requirements.
This publication provides practical reference material for revenue cycle, clinical, and policy teams seeking a concise briefing on J2916: what the code represents, where the service is typically delivered, and the payer landscape that influences access and billing. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J2916 describes an injection of sodium ferric gluconate complex in sucrose, with a specified quantity of 12.5 mg per unit. This code represents an intravenous iron preparation used to treat iron deficiency when oral iron is ineffective or not tolerated.
Service Type: Intravenous injection/infusion medication administration
Typical Site of Service: Outpatient infusion center, hospital outpatient department, or clinic
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with documented iron-deficiency anemia who has an intolerance or inadequate response to oral iron therapy. The patient presents to an outpatient infusion center or hospital outpatient department for intravenous iron replacement. Pre‑infusion evaluation includes verification of diagnosis, baseline vital signs, review of prior iron therapy and allergies, and consent. A peripheral intravenous catheter is placed, and a test dose or slow infusion of J2916 (sodium ferric gluconate complex in sucrose injection, 12.5 mg) is administered per institutional protocol. Vital signs are monitored during and for a period after the infusion to detect hypersensitivity reactions. Repeated doses of J2916 may be given during the same encounter or across multiple visits to reach the total prescribed iron dose, with documentation of lot number, dose, route, and any adverse reactions. Typical sites of service are outpatient infusion centers, hospital outpatient departments, dialysis centers for patients on hemodialysis, and occasionally physician offices equipped for parenteral therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Data not available in the input. | Data not available in the input. |