Summary & Overview
HCPCS Q0138: Ferumoxytol Injection for Iron Deficiency Anemia, Non-ESRD
HCPCS Level II code Q0138 denotes an intravenous injection of ferumoxytol for the treatment of iron deficiency anemia in patients not receiving dialysis. As a parenteral iron replacement option, ferumoxytol has national clinical relevance for outpatient infusion services and specialty clinics treating iron-deficient patients who cannot tolerate or do not respond to oral iron.
Key payers referenced in standard coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for ferumoxytol use, typical sites of service, common billing modifiers, and payer coverage considerations where available. The publication outlines benchmarks and patterns relevant to utilization and reimbursement coding for non-ESRD ferumoxytol injections, highlights any recent policy or coverage updates when present, and summarizes coding best practices for accurate claim submission.
This analysis is intended for a national audience of clinicians, coding professionals, and revenue-cycle stakeholders seeking a clear summary of HCPCS Level II code Q0138, its clinical application, and the payer landscape for non-ESRD iron therapy in outpatient infusion settings.
Billing Code Overview
HCPCS Level II code Q0138 describes an injection of ferumoxytol for the treatment of iron deficiency anemia, dosed at 1 mg per unit and specified for non-ESRD use. This service is a parenteral iron therapy administered intravenously for patients with iron deficiency anemia who are not on end-stage renal disease (ESRD) dialysis.
Service Type: Therapeutic infusion/injection (iron replacement therapy)
Typical Site of Service: Outpatient infusion center, hospital outpatient department, or clinic-based infusion setting
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with symptomatic iron deficiency anemia who has intolerance or inadequate response to oral iron therapy. The patient is referred to an infusion center by a hematologist or primary care provider after lab confirmation of low hemoglobin and low ferritin or transferrin saturation. Prior to administration of Q0138 (ferumoxytol injection, 1 mg unit), medication reconciliation, informed consent, allergy review, and baseline vital signs are documented. Intravenous access is established and the dose is prepared per product labeling. The patient receives the infusion in an outpatient infusion suite, ambulatory surgery center, or hospital outpatient department with monitoring for infusion reactions for at least 30 minutes after completion. Nursing documents lot number, volume administered, and any immediate adverse reactions. Post-infusion orders include follow-up labs (complete blood count, ferritin, iron studies) in 4–8 weeks and clinical reassessment by the ordering provider. Billing for Q0138 is per milligram; documentation must support the total milligrams administered and clinically appropriate use (non-ESRD iron deficiency anemia).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug amount discarded/not administered | When a single-use vial contained excess ferumoxytol that was discarded and documentation of discarded amount is required |