Does J1437 require prior authorization?

Yes, J1437 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J1437?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`J1437`, Injection, ferric derisomaltose, 10 mg

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documented diagnosis of iron deficiency anemia (including whether related to chronic kidney disease, dialysis status, heart failure, cancer/chemotherapy, or other cause).
Patient age (to confirm ≥18 years).

For 'Iron Deficiency Anemia, Other' requests: documentation of prior oral iron therapy and evidence it was ineffective or intolerable, OR documentation of a condition that interferes with oral iron absorption (example given: inflammatory bowel disease), OR documentation the patient is receiving an erythropoiesis-stimulating agent, OR documentation that the request is for cancer- or chemotherapy-related anemia.

Key Coverage Criteria

Treatment of iron deficiency anemia in adult patients who have intolerance to oral iron or have had unsatisfactory response to oral iron (FDA-approved).
Treatment of iron deficiency anemia in adult patients with non-hemodialysis dependent chronic kidney disease (FDA-approved).
Iron deficiency anemia in patients with chronic kidney disease who are on dialysis (approved off-label compendial use).
Iron deficiency in patients with heart failure (approved off-label compendial use).
Iron deficiency anemia, other: adult patients (18 years or older) who meet one of the following: tried oral iron supplementation but it was ineffective or intolerable; OR have a condition that will interfere with oral iron absorption (e.g., inflammatory bowel disease); OR are currently receiving an erythropoiesis-stimulating agent (e.g., epoetin alfa, darbepoetin alfa, methoxy polyethylene glycol-epoetin beta); OR Monoferric is being requested for cancer or chemotherapy-related anemia.
Feraheme and Injectafer are medically necessary when the following criteria are met: For initial therapy, all of the following: o Submission of medical records (e.g., lab values, chart notes, etc.) supporting the diagnosis of IDA; and o Patient does not have CKD; and o One of the following: History of failure, contraindication, or intolerance, to oral iron therapy; or Intravenous Iron Replacement Therapy (Feraheme®, Injectafer®, & Monoferric®) Page 1 of 11

9 Active Policies

HEALTHNET_OR-HNOR-FERRIC-DERISOMALTOSE-MONOFERRIC-CP-PHAR-480-D5DD84597E, Ferric Derisomaltose (Monoferric); CP.PHAR.480

MODA-MONOFERRIC-E545F01898, Monoferric (ferric derisomaltose)

SUREST-POL-SUREST-iv-iron-replacement-therapy, Intravenous Iron Replacement Therapy (Feraheme, Injectafer, & Monoferric)

EVICORE-MEDICAL_DRUG-602A40C97B17, Monoferric (ferric derisomaltose)

EVICORE-MEDICAL_DRUG-B1D3B3C94BC8, Monoferric (ferric derisomaltose)Effective 09/01/2026

UHC-COMM-MD-INTRAVENOUS-IRON-REPLACEMENT-THERAPY-FER-FA4B9114CF, Intravenous Iron Replacement Therapy (Feraheme, Injectafer, & Monoferric) – Community Plan Medical Benefit Drug Policy

UHC-POL-iv-iron-replacement-therapy, Intravenous Iron Replacement Therapy (Feraheme, Injectafer, & Monoferric)

UHC-EXCH-MD-INTRAVENOUS-IRON-REPLACEMENT-THERAPY-FER-77E39326F4, Intravenous Iron Replacement Therapy (Feraheme, Injectafer, & Monoferric) – Individual Exchange Medical Benefit Drug Policy

UMR-POL-UMR-iv-iron-replacement-therapy, Intravenous Iron Replacement Therapy (Feraheme, Injectafer, & Monoferric)

`J1437`, Injection, ferric derisomaltose, 10 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

J1437, Injection, ferric derisomaltose, 10 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

`J1437`, Injection, ferric derisomaltose, 10 mg