96365 is the code for a Feraheme infusion in almost every case. The label requires the 510 mg dose to run by infusion pump for at least 15 minutes, and CMS counts anything documented at 16 minutes or more as an infusion. 96374 only applies on the rare claim where the infusion is charted at exactly 15:00 flat — CMS defines “push” by the clock (15 minutes or less), not by whether the drug was ever injected by hand. Bill the drug itself as Q0138 (non-ESRD) or Q0139 (ESRD on dialysis), 510 units for the standard dose either way.
Ferumoxytol has two permanent HCPCS codes that split on the patient’s renal status, not on the dose or the setting: Q0138 for iron-deficiency anemia in a patient who is not on dialysis, and Q0139 for a patient with end-stage renal disease on dialysis. The drug, the 510 mg vial and the infusion time are identical under either code — only the ESRD/dialysis status decides which one goes on the claim, and it has to be decided before the CPT administration code is even relevant. Both codes bill 1 mg per unit and carry the same MUE, 510 units, practitioner and facility, MAI 3 (2026 Q3 and Q4 NCCI MUE table) — which is not a coincidence, since the standard dose is exactly one 510 mg vial and the MUE is set to match it.
Feraheme's original 2009 label allowed a rapid undiluted injection. A March 2015 label revision, added after post-marketing reports of serious hypersensitivity including fatal anaphylaxis, replaced that with a Boxed Warning and a mandatory infusion: dilute in 50 to 200 mL of saline or D5W and infuse over at least 15 minutes. The current label states plainly that the prior method of administration — the rapid intravenous injection — is no longer approved. That label change retired a technique. It did not rewrite how Medicare draws the line between the push codes and the infusion codes, which has nothing to do with syringe versus pump and everything to do with the clock:
“For chemotherapy administration and therapeutic, prophylactic and diagnostic injections and infusions, an intravenous or intra-arterial push is defined as: 1.) an injection in which the healthcare professional is continuously present to administer the substance/drug and observe the patient; or 2.) an infusion of 15 minutes or less.” — CMS Pub. 100-04 Ch. 12 §30.5
An infusion documented at 16 minutes or more falls outside that definition and is 96365. An infusion documented at exactly 15 minutes — the label’s own floor — is still “15 minutes or less,” and by the letter of the CMS rule that is still a push, 96374, even though it was delivered by infusion pump rather than by hand. In practice this makes 96374 uncommon for Feraheme: most infusion pumps are not set to stop at the exact 15:00 mark, and running a hair past it into 16 minutes moves the claim to 96365. But it is not impossible, and a chart that documents exactly 15:00 start-to-stop does not get to round up to 96365 just because the drug’s label calls the whole thing an infusion. Chart the actual stop time; the difference between 15:00 and 16:00 is the difference between the two codes.
Q0138 and Q0139 both bill 1 mg per unit, so the standard 510 mg dose is 510 units — the full MUE ceiling, on every ordinary claim. The vial is a 510 mg/17 mL single-dose container with no smaller size on the label, so a standard dose draws exactly one vial with nothing left over: JZ is the modifier on virtually every Feraheme line. JW, for a discarded portion, would only apply if an infusion were interrupted partway through by an adverse reaction before the full 510 mg was administered — an unusual event, and one that would need its own documentation of how much of the vial was actually given.
Feraheme’s course is two 510 mg doses, 3 to 8 days apart. That is two separate encounters, not one course billed on a single claim: each date of service gets its own Q0138 (or Q0139) line at 510 units and its own administration code, decided independently by that visit’s documented infusion time. A first dose charted at 20 minutes (96365) and a second dose eight days later charted at exactly 15 minutes (96374) is a perfectly ordinary pair of claims — the two visits do not have to match, and nothing about dose two depends on how dose one was coded.
The label requires observing the patient for hypersensitivity for at least 30 minutes after the infusion ends, with resuscitation equipment available. There is no CPT code for post-infusion observation, and none is needed — the requirement is a safety-monitoring instruction, not a billable service, and the time and staff attention it takes are already built into the practice-expense value of the administration code itself. Say it plainly: the observation period does not appear on the claim in any form, not as a second unit of 96365, not as a separate line, and not as time added to the infusion minutes used to pick 96365 versus 96374. Only the infusion itself — start of the drip to stop of the drip — counts toward that 15/16-minute line.
Fluids run to keep the line open during the infusion are incidental and not separately billable, the same as on any other drug administration claim. Full unit math for either dose, or for the ESRD code: the Q0138 units calculator.
96365, in almost every case — the label requires at least 15 minutes and most documented infusions run 16 minutes or more, which is 96365. 96374 applies only when the chart shows exactly 15:00 minutes, since CMS defines a push as 15 minutes or less regardless of the delivery method.
Yes, on a documented 15-minute-flat infusion. The 2015 label change removed the rapid undiluted injection technique (the label now states that method of administration is no longer approved); it did not change how CMS separates push codes from infusion codes, which is done by the clock (Pub. 100-04 Ch. 12 §30.5), not by whether a syringe or a pump delivered the drug.
Q0138 for iron-deficiency anemia in a patient who is not on dialysis; Q0139 for a patient with end-stage renal disease on dialysis. Same drug, same 510 mg dose, same NDC — the code turns entirely on the patient’s renal and dialysis status, confirmed before the claim is built.
No. There is no CPT code for it. It is a safety-monitoring requirement on the label, and its time is already reflected in the practice-expense value of 96365 (or 96374); it does not add a unit, a line, or minutes toward the push-vs-infusion time count.
Quoted passages are reproduced from the cited federal publications; everything else is our reading of them. The methodology by which we resolve source disagreements is described in the Methodology.