Does Q0139 require prior authorization?

Yes, Q0139 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for Q0139?

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

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`Q0139`, Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for esrd

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

MRI is employed only when ultrasonography is not feasible or when ultrasonographic findings are not diagnostic (VSD evaluation).
For transplant rejection pilot studies: biopsies were graded according to the International Society for Heart Lung Transplant system for cellular rejection with immunohistochemistry for humoral rejection — (implying biopsy correlation is used in study settings).

Documentation that prior echocardiogram (including TTE/TEE as applicable) was inconclusive or expected to be nondiagnostic when MRI is requested for cardiac function, morphology, or valvular disease

When MRI is requested in lieu of SPECT for myocardial perfusion/ischemia assessment: documentation that the member meets medical necessity criteria for cardiac SPECT and rationale for using MRI instead of SPECT

For cases where multiple diagnostic procedures (e.g., CT, SPECT, ultrasound, MRI) are performed, physician documentation of the compelling reason for multiple tests and specifically what information is expected from the MRI that prior testing did not or could not provide

Key Coverage Criteria

B58.81 Toxoplasma myocarditis
C34.00 - C38.8 Malignant neoplasm of bronchus and lung, thymus, heart, mediastium and pleura
C45.0 C45.2 Mesothelioma of pleura and pericardium
C47.3, C49.3 Malignant neoplasm of peripheral nerves of thorax and connective and soft tissue of thorax
I70.201 - I70.799; I70.92 Atherosclerosis
I71.00 - I71.9 Aortic aneurysm and dissection

10 Active Policies

HEALTHNET_OR-HNOR-FERUMOXYTOL-FERAHEME-CP-PHAR-165-1291A96F9C, Ferumoxytol (Feraheme); CP.PHAR.165

MODA-FERAHEME-FF575CE1CE, Feraheme (ferumoxytol)

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

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

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

AETNA-CPB-0520, Magnetic Resonance Imaging of the Cardiovascular System - Cardiac MRI

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

EVICORE-MEDICAL_DRUG-02D9620C4CE3, Ferumoxytol Injection (Feraheme, generic)Effective 09/01/2026

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

EVICORE-MEDICAL_DRUG-2BDF89EEE950, Feraheme (ferumoxytol)

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Q0139, Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for esrd