FERAHEME billing and coding information for outpatient services

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HCPCS1 Injection, ferumoxytol, for treatment of IDA, 1 mg Q0138 non-ESRD use OR Q0139 ESRD on dialysis
Drug administration CPT® codes2† 96365  Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
National Drug Codes (NDC)3‡ 59338-775-01  FERAHEME 510 mg/17 mL, 1 vial
Diagnosis codes (ICD-10)4 D50.0
Blood loss (chronic)

D50.1
Sideropenic dysphagia

D50.8
Poor iron absorption

D50.9
Iron deficiency anemia, unspecified


Confirm iron deficiency before using the following codes:

D63.0
Anemia in neoplastic disease
CODE NEOPLASM FIRST

D63.1
Anemia in chronic kidney disease
CODE CKD STAGE

D63.8
Anemia in other chronic diseases classified elsewhere
CODE UNDERLYING DISEASE FIRST

D64.81
Antineoplastic chemotherapy-induced anemia

*This table is provided for informational purposes only. Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and specific billing requirements. AMAG Pharmaceuticals, Inc. does not make any representation or guarantees concerning reimbursement or coverage for any service or item.

†CPT® is a registered trademark of the American Medical Association.

‡Payer requirements regarding 10-digit and 11-digit NDC may vary.

CKD=chronic kidney disease; CPT=Current Procedural Terminology; ESRD=end-stage renal disease; HCPCS=Healthcare Common Procedure Coding System; ICD=International Classification of Diseases; IDA=iron deficiency anemia.

Diagnosis codes
(ICD-10)1		 E83.10
Iron metabolism

E83.19
Other disorders of iron metabolism, specified NEC

K50.00, K50.90, K50.919
Crohn’s disease (regional enteritis)

K51.00, K51.90, K51.919
Pancolitis, ulcerative colitis, complication

K90.0
Celiac disease

K90.49
Malabsorption due to intolerance

K90.89
Intestinal malabsorption, specified NEC

K90.9
Intestinal malabsorption

N18.1
CKD, stage 1

N18.2
CKD, stage 2

N18.3
CKD, stage 3

N18.4
CKD, stage 4

N18.5
CKD, stage 5

N18.6
CKD, end-stage (failure)

N18.9
CKD

N92.0, N92.6
Excessive, frequent, and irregular menstruation

N95.0
Postmenopausal bleeding

T45.4X5 [A,S,D]
Adverse effect of iron and its compounds

T50.905 [A,S,D]
Adverse effect of unspecified drugs, medicaments, and biological substances

 

*This table is provided for informational purposes only. Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and specific billing requirements. AMAG Pharmaceuticals, Inc. does not make any representation or guarantees concerning reimbursement or coverage for any service or item.

CKD=chronic kidney disease; ICD=International Classification of Diseases; NEC=not elsewhere classified.

References: 1. Centers for Medicare & Medicaid Services, US Department of Health and Human Services. HCPCS 2018 index. https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS-Items/2020-Alpha-Numeric-HCPCS-File. Accessed March 2, 2020. 2. American Medical Association. Current Procedural Terminology 2017: Professional Edition. Chicago. IL: American Medical Association; 2016. 3. Feraheme [prescribing information]. AMAG Pharmaceuticals, Inc; September 2020. 4. Centers for Medicare & Medicaid Services. 2018 code tables and index. https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2018-ICD-10-Table-And-Index.zip. Accessed February 28, 2020.

References: 1. Centers for Medicare & Medicaid Services, US Department of Health and Human Services. HCPCS 2018 index. https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS-Items/2020-Alpha-Numeric-HCPCS-File. Accessed March 2, 2020. 2. American Medical Association. Current Procedural Terminology 2017: Professional Edition. Chicago. IL: American Medical Association; 2016. 3. Feraheme [prescribing information]. AMAG Pharmaceuticals, Inc; February 2018. 4. Centers for Medicare & Medicaid Services. 2018 code tables and index. https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2018-ICD-10-Table-And-Index.zip. Accessed February 28, 2020.

Reference: 1. Centers for Medicare & Medicaid Services. 2018 code tables and index. https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2018-ICD-10-Table-And-Index.zip. Accessed February 28, 2020.