10 commercial payer policies list Q0139. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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10 policies from 7 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
| Policy | Effective | Status of Q0139 |
|---|---|---|
| Feraheme (ferumoxytol)Effective 03/01/2025 - 08/31/2025 | Oct 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Feraheme (ferumoxytol)Effective 09/01/2025 - 08/31/2026 | Sep 1, 2025 | Prior auth requiredInferred from policy title |
| Ferumoxytol Injection (Feraheme, generic) | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of Q0139 |
|---|---|---|
| Intravenous Iron Replacement Therapy (Injectafer & Monoferric) | Sep 1, 2026 | Covered |
| Intravenous Iron Replacement Therapy (Feraheme, Injectafer, & Monoferric) – Community Plan Medical Benefit Drug Policy | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of Q0139 |
|---|---|---|
| Magnetic Resonance Imaging of the Cardiovascular System - Cardiac MRI | Aug 1, 2023 | Covered |
| Policy | Effective | Status of Q0139 |
|---|---|---|
| Ferumoxytol (Feraheme); CP.PHAR.165 | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of Q0139 |
|---|---|---|
| Feraheme (ferumoxytol) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of Q0139 |
|---|---|---|
| Intravenous Iron Replacement Therapy (Injectafer & Monoferric) | Sep 1, 2026 | Covered |
| Policy | Effective | Status of Q0139 |
|---|---|---|
| Intravenous Iron Replacement Therapy (Injectafer & Monoferric) | Sep 1, 2026 | Covered |