Does J1439 require prior authorization?

Yes, J1439 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for J1439?

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

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`J1439`, Injection, ferric carboxymaltose, 1 mg

HCPCS/CPT

Prior Authorization

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Clinical notes or consultation reports when specialty consultation is required (nephrology, hematology, cardiology).
Patient age documented (must meet age criteria for the requested indication: ≥1 year for general IDA; ≥18 years for CKD non-dialysis and heart failure indications).

For 'Iron Deficiency Anemia, Other': documentation of trial of oral iron supplementation and reason it was ineffective or intolerable, OR documentation of a condition interfering with oral iron absorption (e.g., inflammatory bowel disease), OR documentation that the patient is currently receiving an erythropoiesis-stimulating agent, OR documentation that the request is for cancer or chemotherapy-related anemia.

Key Coverage Criteria

Iron deficiency anemia in adult and pediatric patients 1 year of age and older who have either intolerance or an unsatisfactory response to oral iron.
Iron deficiency anemia in adult patients who have non-dialysis dependent chronic kidney disease.
Iron deficiency in adult patients with heart failure and New York Heart Association class II/III to improve exercise capacity.
Approved off-label compendial use: Iron deficiency anemia in patients with chronic kidney disease who are on dialysis.
Coverage guideline — Iron Deficiency Anemia in Patients with Chronic Kidney Disease: The individual must meet both of the following criteria for approval: Is 18 years of age or older; Injectafer is prescribed by or in consultation with a nephrologist or hematologist.
Coverage guideline — Iron Deficiency Anemia, Other: The individual must meet both of the following criteria for approval: Is one year of age or older; Must meet one of the following: Has tried oral iron supplementation but was ineffective or intolerable; OR Has a condition which will interfere with oral iron absorption (e.g., inflammatory bowel disease); OR Is currently receiving an erythropoiesis-stimulating agent (e.g., an epoetin alfa product, a darbepoetin alfa product, or a methoxy polyethy [...]

9 Active Policies

HEALTHNET_OR-HNOR-FERRIC-CARBOXYMALTOSE-INJECTAFER-CP-PHAR-234-2C404497BB, Ferric Carboxymaltose (Injectafer); CP.PHAR.234

MODA-INJECTAFER-C3672BD661, Injectafer (ferric carboxymaltose injection)

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

EVICORE-MEDICAL_DRUG-C0EDB4D9356E, Injectafer (ferric carboxymaltose)Effective 09/01/2026

EVICORE-MEDICAL_DRUG-FFBF9E580E48, Injectafer (ferric carboxymaltose)

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)

`J1439`, Injection, ferric carboxymaltose, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

J1439, Injection, ferric carboxymaltose, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

`J1439`, Injection, ferric carboxymaltose, 1 mg