HCPCS
J1750
1 unit = 50 mg (NOT 1 mg)
Phase 1
Identify what you're billing
Confirm the right unit basis (50 mg!), test dose, monitoring, and indication.
IV iron class — how INFeD compares CMS ASP Q2 2026
Five major IV iron products. INFeD is the oldest, has the lowest per-mg ASP, and is the only one with a Boxed Warning combined with a mandatory test dose — which together explain its last-line positioning in modern algorithms.
| Brand (generic) | HCPCS | Unit basis | Test dose | Boxed warning | Per mg ASP+6% |
|---|---|---|---|---|---|
| INFeD (iron dextran LMW) | J1750 |
50 mg / unit | YES — required | YES — anaphylaxis | ~$0.362 (Q2 2026) |
| Injectafer (ferric carboxymaltose) | J1439 |
1 mg / unit | No | No (hypoP W&P) | ~$1.103 |
| Monoferric (ferric derisomaltose) | J1437 |
1 mg / unit | No | No | ~$1.10 (verify CMS file) |
| Feraheme (ferumoxytol) | Q0138 (non-ESRD) |
1 mg / unit | No | YES — hypersensitivity | ~$1.04 (verify CMS file) |
| Venofer (iron sucrose) | J1756 |
1 mg / unit | No | No | ~$0.40 (verify CMS file) |
Two structural disadvantages drive INFeD's last-line positioning. (1) Test dose adds
chair time, observation time, and a separate billable encounter for every new course; (2) Boxed Warning
for anaphylaxis means every administration must occur in a setting with full resuscitation capability,
even after the test dose is tolerated. The lowest per-mg drug cost is offset by higher admin volume,
higher liability footprint, and lower patient throughput.
The 50 mg unit basis is unique. J1750 is a legacy descriptor from the early HCPCS era
when iron dextran was the dominant injectable iron and 50 mg was a clinically meaningful unit. All
post-2000 IV iron HCPCS codes (J1437, J1439, J1756, Q0138) standardized on 1 mg per unit. Translating
between products requires explicit unit conversion at the claim line.
Dosing & unit math FDA label / Ganzoni formula
INFeD total iron dose is calculated, not fixed. Use the Ganzoni formula based on the patient's hemoglobin deficit and lean body weight, then divide into clinically practical sessions.
Ganzoni total dose calculation
# Ganzoni formula
Total iron mg = body weight (kg) × (Hgb target − Hgb actual) g/dL × 2.4 + iron stores
# Typical adult example
70 kg patient, Hgb 8.0 g/dL, target 14.0 g/dL, iron stores 500 mg
= 70 × (14 − 8) × 2.4 + 500
= 70 × 6 × 2.4 + 500
= 1,008 + 500
Total iron required: ~1,500 mg cumulative
Total iron mg = body weight (kg) × (Hgb target − Hgb actual) g/dL × 2.4 + iron stores
# Typical adult example
70 kg patient, Hgb 8.0 g/dL, target 14.0 g/dL, iron stores 500 mg
= 70 × (14 − 8) × 2.4 + 500
= 70 × 6 × 2.4 + 500
= 1,008 + 500
Total iron required: ~1,500 mg cumulative
Session-by-session dosing (typical)
- Session 1: Test dose — 0.5 mL (25 mg) IV slow push over ≥30 seconds, observe ≥1 hour. If tolerated, may proceed to therapeutic dose at the same encounter or schedule subsequent sessions.
- Subsequent sessions: typically ≤100 mg per session (one full vial) IV infusion or slow IV push
- Total dose infusion (TDI): single-session administration of total calculated dose over 4–6 hours — off-label use, requires extended observation, common in obstetric and outpatient hematology settings
Unit math — the 50 mg trap
# Convert mg administered to J1750 units
Units = mg administered ÷ 50
# Worked examples
25 mg test dose → 0.5 units (round per MAC; many accept 1 unit billed for the full vial used + JW for waste)
100 mg therapeutic session → 2 units (NOT 100)
500 mg TDI cumulative → 10 units (NOT 500)
1,000 mg full Ganzoni course → 20 units (NOT 1,000)
Units = mg administered ÷ 50
# Worked examples
25 mg test dose → 0.5 units (round per MAC; many accept 1 unit billed for the full vial used + JW for waste)
100 mg therapeutic session → 2 units (NOT 100)
500 mg TDI cumulative → 10 units (NOT 500)
1,000 mg full Ganzoni course → 20 units (NOT 1,000)
The single most common INFeD billing error is keying the mg amount as units instead of
converting first. A 100 mg dose billed as 100 units instead of 2 units generates a claim for 5,000 mg of
iron dextran — 50× the correct charge. The CMS claim system will accept the line at face
value; the error surfaces only at audit or downstream MAC analytics review.
Pediatric dosing
- Approved for children ≥4 months
- Test dose: 0.025 mL/kg (max 25 mg)
- Therapeutic dosing: weight-based per Ganzoni; max single session typically 100 mg
- Bill actual mg administered ÷ 50 for J1750 units; partial-vial waste extremely common in pediatric dosing — bill JW
NDC reference FDA NDC Directory verified May 2026
| NDC (10/11-digit) | Package | Use |
|---|---|---|
0023-6082-10 / 00023-6082-10 |
100 mg / 2 mL (50 mg/mL elemental iron) single-dose vial — Allergan/AbbVie labeler | Standard INFeD vial; 1 vial per single therapeutic session at 100 mg dosing; partial-vial waste expected for 25 mg test dose and pediatric weight-based dosing |
Verify the labeler's current NDC at billing time. Allergan acquired the INFeD product
through prior consolidation; the NDC may appear under an Allergan or AbbVie labeler depending on the
carton on hand. Use the 11-digit padded form for most commercial payers (5-4-2 format) and the N4
qualifier in box 24A shaded area on CMS-1500. The NDC above is a representative reference; cross-check
against the carton on hand.
Historical note — DexFerrum NDCs. DexFerrum (high molecular weight iron dextran)
was withdrawn from the US market in 2009 due to higher rates of anaphylaxis. Any historical claim or
chart record citing DexFerrum NDCs should not be matched to current INFeD claims. Both products
historically billed under J1750 but only INFeD remains marketed.
Test dose — required at every new course FDA label requirement
INFeD is the only currently marketed IV iron in the US that requires a mandatory test dose. The test dose requirement is a structural part of every new course of therapy — not optional, not waivable on rechallenge.
Per the FDA label: administer 0.5 mL (25 mg) of INFeD by slow intravenous injection
over a period of at least 30 seconds, then observe the patient for at least 1 hour for signs and
symptoms of anaphylactoid-type reactions before initiating the full therapeutic dose. The test
dose must be repeated at every new course of therapy, even in patients who have previously
tolerated INFeD without reaction.
Test dose protocol
- Volume: 0.5 mL undiluted (= 25 mg elemental iron) — pediatric: 0.025 mL/kg (max 25 mg)
- Route: slow IV injection over ≥30 seconds (some sites administer as a brief slow IV push)
- Observation: ≥1 hour with patient supine or seated, with full resuscitation capability immediately available
- Vital sign monitoring: per institutional protocol; many sites check BP, HR, SpO2 at baseline, 5 min, 15 min, 30 min, 60 min
- Documentation: chart the exact administration time, observation duration, vital sign trend, and absence (or presence) of any reaction
Test dose reactions — what to watch for
- Acute anaphylactoid reaction: hypotension, dyspnea, chest pain, urticaria, angioedema, bronchospasm
- Delayed reactions (1–48 hours): arthralgia, myalgia, malaise, fever, lymphadenopathy
- Vasovagal-type reaction: bradycardia, hypotension, lightheadedness
- Discontinue immediately on any reaction; do not proceed to therapeutic dose
Billing the test dose
- Drug line:
J1750for the iron units administered (25 mg = 0.5 units — bill per MAC rounding policy; most MACs accept 1 unit billed for the full vial used with JW for the unused 75 mg) - Admin line:
96374(therapeutic IV push, single drug) is the most common admin code for the test dose - Observation: separate observation codes (e.g., G0378/G0379) generally do not apply for the in-suite 1-hour observation period; the observation is bundled into the infusion-suite encounter
- If the test dose is followed at the same encounter by the therapeutic dose, bill 96374 for the push + 96365 for the subsequent infusion (initial substance), with appropriate hierarchy modifiers per CPT infusion rules
Common error: billing the full Ganzoni cumulative-dose units on the test-dose encounter
because the chart documents the calculated total. Bill only the units actually administered at the
encounter (test dose only = 25 mg; subsequent encounters bill their own administered units).
Boxed Warning — serious hypersensitivity / anaphylaxis FDA label / current
The Boxed Warning has been part of the INFeD label throughout its modern history. Every encounter must be conducted as if anaphylaxis is a real possibility, regardless of prior tolerance.
Boxed Warning text (paraphrased): serious hypersensitivity reactions including
anaphylactoid-type reactions, some of which have been fatal, have been reported following INFeD
administration. Such reactions can occur even in patients who have previously tolerated INFeD without
reaction, including after a tolerated test dose. INFeD should be administered only by healthcare
professionals trained to recognize and treat anaphylaxis, and only when resuscitation equipment and
therapies for managing anaphylaxis are immediately available.
Risk factors for hypersensitivity
- History of multiple drug allergies
- History of atopic disease (asthma, eczema, allergic rhinitis)
- Prior reaction to any iron dextran product (INFeD, historical DexFerrum)
- Active connective tissue disease (rheumatoid arthritis, SLE)
- Prior reaction to a non-dextran IV iron is not an absolute contraindication but warrants caution
Site requirements for INFeD administration
- Healthcare professional with training in anaphylaxis recognition and management on site
- Epinephrine, IV antihistamines, IV corticosteroids, IV fluids, supplemental oxygen, suction, airway equipment immediately available
- Direct visual observation of patient during test dose and for ≥1 hour after
- Direct visual observation of patient during therapeutic dose and for at least 30 minutes after completion
- Many infusion centers protocol INFeD only in chair positions adjacent to a fully equipped crash cart
Pregnancy considerations
Some obstetric and maternal-fetal medicine protocols still favor INFeD for IDA in pregnancy, particularly when oral iron has failed and when total dose infusion is needed before delivery. The rationale is INFeD's long pregnancy use history (Pregnancy Category B historically) versus the more recent IV iron approvals. Sites that administer INFeD in pregnancy must follow institutional protocols that align with the Boxed Warning — hospital-based or hospital-affiliated infusion suite with full resuscitation capability is the typical setting.
Last-line positioning in modern IV iron algorithms Reviewed May 2026
Most major payer formularies and infusion-center protocols now position INFeD behind the non-dextran IV irons. Understanding why explains the PA pathway and the documentation needed to get INFeD approved when it is the right product.
Why modern algorithms prefer non-dextran IV irons first
- Lower anaphylaxis risk — meta-analyses consistently show iron dextran (even LMW INFeD) has higher anaphylaxis rates than ferric carboxymaltose, ferric derisomaltose, ferumoxytol, and iron sucrose
- No test dose burden — non-dextran IV irons skip the 1-hour observation, the separate test-dose encounter, and the documentation overhead
- Higher dose-per-visit — Injectafer (750 mg in ~15 min), Monoferric (1,000 mg in ~20 min), Feraheme (510 mg in ~15 min) deliver a full course in 1–2 visits versus INFeD's typical 100 mg per session over 5–10 sessions
- Better infusion-suite throughput — fewer chair hours per patient, lower admin-code volume per course
When INFeD is still the right product
- Documented intolerance or allergic reaction to one or more non-dextran IV irons
- Pregnancy IDA per institutional obstetric protocol (legacy preference at some centers)
- Off-label single-session total dose infusion (TDI) needed and the institution has a TDI protocol with extended observation
- Cost-driven payer mandate where the lowest per-mg ASP is decisive (rare in 2026; most plans now prefer non-dextran)
- Pediatric dosing where weight-based 100 mg-or-less per session aligns with INFeD's vial size
PA pathway when prescribing INFeD: document the clinical rationale clearly —
prior non-dextran IV iron failure or intolerance, pregnancy protocol indication, or TDI clinical need.
Most commercial payers will approve INFeD with documented step therapy through Injectafer or Venofer.
Cite the FDA label indication ("when oral iron is unsatisfactory or impossible") plus the specific
non-dextran failure documentation in the PA letter.
Common payer step therapy: UnitedHealthcare, Aetna, and many BCBS plans require
documented failure or intolerance of at least one non-dextran IV iron (typically Injectafer or Venofer)
before approving INFeD. Submit the prior IV iron product, dose, dates, and reason for discontinuation
in the PA submission.
Phase 2
Code the claim
Test dose admin (96374) + therapeutic infusion admin (96365). Don't bill chemo admin codes. Convert mg to units before keying.
Administration codes CPT verified May 2026
INFeD is non-chemotherapy — therapeutic IV codes apply. The test dose is typically billed as IV push; subsequent therapeutic dosing as IV infusion or IV push depending on protocol.
| Code | Description | When to use |
|---|---|---|
96374 |
Therapeutic IV push, single or initial drug | Test dose admin code. The 25 mg test dose given over ≥30 seconds is correctly billed as IV push. Also used for therapeutic IV push when the protocol delivers slow IV push instead of infusion. |
96365 |
Therapeutic IV infusion, up to 1 hour, single or initial drug | Standard 100 mg therapeutic infusion over 1 hour. Use as the initial admin code when the test dose is on a separate encounter and the infusion is the only billed admin at this visit. |
96366 |
Each additional hour of therapeutic IV infusion | Add for total dose infusion (TDI) protocols running 4–6 hours. Bill 96365 for hour 1 + 96366 for each additional hour. |
96375 |
Each additional sequential IV push | Use when the same encounter delivers test dose (96374) followed by additional IV push administration of the therapeutic dose. Verify with payer. |
96413 |
Chemotherapy administration, IV infusion | NOT appropriate. INFeD is non-chemotherapy; do not use chemo admin codes. |
Same-encounter test dose + therapeutic dose: when both are administered at one
encounter, follow CPT infusion hierarchy — the longer/more complex service is the initial code,
with subsequent/additional administrations billed as add-ons. Most commonly: 96374 for test dose push
+ 96365 for the subsequent therapeutic infusion as initial substance/drug. Confirm with each payer.
Total Dose Infusion (TDI) is off-label. TDI is a single-session administration of the
full Ganzoni-calculated cumulative dose, typically over 4–6 hours. Some payers will not
reimburse TDI without specific medical necessity documentation. Bill 96365 + 96366 (each additional
hour) and submit chart documentation of the Ganzoni calculation, the TDI clinical rationale, and the
observation protocol.
Modifiers CMS verified May 2026
JZ — full vial used with no waste
Effective July 1, 2023, CMS requires the JZ modifier on all single-dose container claims when no drug is discarded. INFeD ships in 100 mg / 2 mL single-dose vials. JZ applies whenever the full 100 mg vial is administered with no waste — most commonly the standard 100 mg therapeutic session.
JW — partial-vial waste (test dose, pediatric, weight-based)
JW reports the discarded portion of a single-dose vial. For INFeD, JW applies frequently:
- Test dose: 25 mg administered + 75 mg discarded from the 100 mg vial. Bill the units administered + JW with the discarded units on a separate line.
- Pediatric weight-based: e.g., 15 kg child receiving 25 mg test dose followed by 50 mg sessions — substantial partial-vial waste at every session.
- Sub-100 mg adult sessions: some protocols deliver 50–75 mg per session — JW applies for the discarded mg.
Unit rounding for fractional doses. J1750 unit basis is 50 mg. A 25 mg test dose is
0.5 units in strict math. Most MACs will not pay for 0.5 units — common practice is to bill 1
unit for the full vial used + JW with the discarded units (in mg, not units, depending on MAC). Verify
the rounding policy and waste-line format with your specific MAC; document the calculation in the
chart to support audit defense.
Modifier 25 — same-day E/M
Use modifier 25 on the E/M code when a significant, separately identifiable evaluation and management service is performed on the same day as the infusion. The pre-infusion clinical assessment (test dose risk evaluation, prior reaction history) is commonly bundled into the infusion encounter; the E/M modifier 25 applies only when a distinct E/M service is documented.
340B modifiers (JG, TB)
For 340B-acquired INFeD, follow your MAC's current 340B modifier policy. INFeD's low per-mg ASP makes the 340B differential smaller in absolute dollars than for higher-cost specialty drugs.
ICD-10-CM by indication FY2026 verified May 2026
INFeD's labeled indication is iron-deficiency anemia when oral iron is unsatisfactory or impossible. CKD anemia is a common clinical context but not a separately labeled indication.
IDA — iron deficiency anemia (primary indication)
| Code | Description |
|---|---|
D50.0 | Iron deficiency anemia secondary to chronic blood loss (e.g., GI, GU, menorrhagia) |
D50.8 | Other iron deficiency anemias |
D50.9 | Iron deficiency anemia, unspecified |
D62 | Acute posthemorrhagic anemia |
D64.9 | Anemia, unspecified (rarely sufficient on its own; pair with workup documentation) |
CKD anemia (clinical context, not labeled indication)
| Code | Description |
|---|---|
N18.1–N18.5 | CKD stages 1-5 (NDD) |
N18.30–N18.32 | CKD stage 3 (3a / 3b / unspecified) |
N18.4 | CKD stage 4 |
N18.5 | CKD stage 5 (non-dialysis-dependent) |
D63.1 | Anemia in chronic kidney disease (pair with N18.x) |
ESRD bundled payment caveat. N18.6 (ESRD) and dialysis-dependent CKD trigger ESRD
bundled payment policy. CMS prefers Venofer or Feraheme in the ESRD bundle; INFeD is not the typical
choice in this setting and most dialysis units do not stock it.
Pregnancy IDA (where INFeD is still used by some protocols)
O99.011— Anemia complicating pregnancy, first trimesterO99.012— Anemia complicating pregnancy, second trimesterO99.013— Anemia complicating pregnancy, third trimester- Pair with D50.x IDA code; document the obstetric rationale for choosing INFeD over a non-dextran IV iron
Site of care & place of service Verified May 2026
Because of the Boxed Warning and test-dose observation requirement, INFeD has stricter site-of-care practical requirements than non-dextran IV irons. Office and ambulatory infusion suite are workable only if full resuscitation capability is available; many infusion centers route INFeD to hospital-affiliated suites for the first course.
| Setting | POS | Claim form | INFeD-specific notes |
|---|---|---|---|
| Physician office (heme, GI, OB-GYN, nephrology) | 11 | CMS-1500 / 837P | Acceptable only with full crash-cart capability and trained anaphylaxis response staff |
| Ambulatory infusion suite (AIC) | 49 | CMS-1500 / 837P | Common; verify resuscitation equipment and staff training |
| Hospital outpatient (on-campus) | 22 | UB-04 / 837I | Sometimes preferred for first INFeD course given Boxed Warning |
| Hospital outpatient (off-campus PBD) | 19 | UB-04 / 837I | Acceptable when crash-cart capability is in place |
| Patient home | 12 | CMS-1500 (with home infusion) | Not appropriate for INFeD given Boxed Warning — rare exceptions only with hospital-grade home infusion vendor |
Home infusion is generally inappropriate for INFeD regardless of payer policy. The
Boxed Warning combined with the test-dose observation requirement effectively requires an institutional
setting with immediate access to advanced resuscitation. Most home infusion vendors will not stock
INFeD; route to AIC or hospital outpatient instead.
Claim form field mapping CMS-1500 conventions
Standard CMS-1500 layout for an INFeD encounter. The unit conversion (mg ÷ 50) happens at field 24G.
| Information | CMS-1500 box | Notes |
|---|---|---|
| NPI | 17b | Rendering provider |
| NDC qualifier + 11-digit NDC + UoM + qty | 24A shaded area | N4 + 00023-6082-10 + ML + 2 (mL) for 100 mg dose; verify carton on hand |
| HCPCS J1750 + JZ (or JW for waste) | 24D (drug line) | JZ when full vial used; JW for test dose waste and pediatric/weight-based partial-vial waste |
| Drug units | 24G | mg administered ÷ 50 (e.g., 100 mg = 2 units, NOT 100 units) |
| CPT 96374 (test dose admin) / 96365 (therapeutic infusion) | 24D (admin line) | Test dose = 96374; therapeutic infusion = 96365 (+ 96366 for each additional hour for TDI) |
| ICD-10 | 21 | D50.x for IDA; pair O99.01x for pregnancy; pair N18.x + D63.1 for CKD anemia context |
| PA number | 23 | Required by major commercial payers; document non-dextran step therapy |
Phase 3
Get paid
PA criteria emphasize step therapy through non-dextran IV irons. Document the clinical rationale for choosing INFeD.
Payer policy snapshot Reviewed May 2026
Major payers gate INFeD on labs (ferritin/TSAT), oral iron history, and step therapy through one or more non-dextran IV irons.
| Payer | PA? | Step therapy | Notes |
|---|---|---|---|
| UnitedHealthcare IV Iron Therapy medical drug policy |
Yes | Step through Injectafer or Monoferric or Feraheme typically required | IDA dx + oral iron failure + non-dextran IV iron failure or intolerance documentation |
| Aetna CPB Parenteral Iron Therapy |
Yes | Generally requires non-dextran step therapy; INFeD acceptable on documented intolerance | Same lab thresholds as for the non-dextran products (ferritin <100 OR TSAT <20%) |
| BCBS plans Vary by plan |
Yes | Plan-specific; many plans treat INFeD as last-line behind 1–2 non-dextran options | Some plans allow INFeD first-line in pregnancy IDA per institutional protocol |
| Medicare (MAC LCDs) No NCD; MAC discretion |
No (PA not required, but documentation expected) | None; MAC LCDs cover INFeD for FDA-approved IDA indication | Test dose documentation expected in the chart; MAC may audit for Boxed Warning compliance setting |
Step therapy through non-dextran IV irons
Most commercial payers require documented oral iron failure or intolerance plus failure or intolerance of at least one non-dextran IV iron before approving INFeD. The non-dextran products typically tried first are Injectafer (formulary preferred at most plans), Venofer (lowest per-mg cost), or Monoferric (single-dose convenience). Submit the prior product, dose, dates, and reason for discontinuation in the PA submission.
Pregnancy IDA exception
Some commercial payers and Medicaid programs allow INFeD as first-line IV iron in pregnancy IDA when oral iron has failed, citing the historical pregnancy use record. Verify with each payer and institutional obstetric protocol.
Medicare reimbursement CMS Q2 2026 (live)
Quarterly ASP from CMS Part B Drug Pricing File. Refreshes automatically each quarter. Note: J1750 unit basis is 50 mg.
Q2 2026 payment snapshot — J1750
Effective April 1 – June 30, 2026 · Based on 4Q25 ASP submissions
ASP + 6%
$18.105
per 50 mg unit (~$0.362/mg)
100 mg dose
$36.21
2 units × ASP+6%
1,000 mg course
$362.10
20 units × ASP+6%
Per-mg comparison: INFeD's ~$0.362/mg drug cost is the lowest among the major IV
irons. The economic story flips, however, when admin codes are added — the test-dose encounter,
the multi-session dosing pattern, and the longer per-encounter chair time often produce a higher total
encounter-level cost than non-dextran alternatives that complete in 1–2 visits. After ~2%
sequestration: ~$355/course actual paid for a 1,000 mg cumulative course (drug cost only).
Coverage
No NCD specific to iron dextran. Coverage falls under MAC LCDs for IV iron therapy and the generic drug-coverage framework. All MACs cover J1750 for the FDA-approved IDA indication with appropriate ICD-10 documentation.
Code history
- J1750 — permanent code; descriptor "Injection, iron dextran, 50 mg" (1 unit = 50 mg elemental iron)
- Legacy descriptor from the early HCPCS era; predates the 1 mg = 1 unit standardization adopted by post-2000 IV iron HCPCS codes
- DexFerrum (HMW iron dextran) historically billed under J1750 but was withdrawn from the US market in 2009
Patient assistance — Allergan / AbbVie Verified May 2026
- Allergan / AbbVie patient assistance: INFeD-specific public-facing copay or PAP infrastructure is limited compared to higher-volume specialty products. Verify directly with Allergan/AbbVie patient services at the time of need.
- AbbVie myAbbVie Assist: general AbbVie patient assistance program may apply for uninsured or underinsured patients meeting income requirements — confirm INFeD coverage at enrollment.
- Foundations: for Medicare patients with IDA, refer to PAN, HealthWell, NeedyMeds — verify open IDA / CKD funds quarterly.
- The relatively low per-mg drug cost means out-of-pocket exposure for INFeD is typically lower than for the modern IV irons even before assistance, but coinsurance on multi-session courses can still be material.
Need to model what a specific patient will actually pay after copay assistance, deductible, coinsurance,
and OOP max? Run a CareCost Estimate — J1750 pre-loaded with the
50 mg unit basis correctly applied.
Phase 4
Fix problems
Top denials: unit-basis errors (50× overstated charges), missing test dose documentation, missing non-dextran step therapy.
Common denials & how to fix them
| Denial reason | Common cause | Fix |
|---|---|---|
| Units appear excessive (50× expected) | Biller keyed mg as units (e.g., 100 units for 100 mg) | Resubmit with units = mg ÷ 50. 100 mg = 2 units. Verify with claim audit before refiling. |
| Test dose not documented | Chart missing 25 mg test dose administration time + observation duration | Document the test dose in the chart for every new course. If documentation is incomplete, address pre-claim before resubmission. |
| Step therapy not met | PA submitted without non-dextran IV iron failure history | Submit Injectafer, Venofer, or Monoferric prior trial documentation (product, dose, dates, reason for discontinuation). |
| Oral iron failure not documented | PA submitted without oral iron trial | Submit chart documentation of oral iron type, dose, duration, reason for failure. |
| Wrong admin code (96413) | Chemo IV billed instead of therapeutic IV | Resubmit with 96374 (test dose push) and/or 96365 (therapeutic infusion). INFeD is non-chemotherapy. |
| JZ missing on full-vial claim | Single-dose vial claim without JZ | Resubmit with JZ. Required since 7/1/2023 on every claim with no waste. |
| JW missing on test-dose or pediatric encounter | Wasted drug not reported | Add JW line with discarded units. JZ-style admin line for the units administered; JW line for waste. |
| Site-of-care concerns (home infusion) | INFeD attempted as home infusion | Move to AIC (POS 49) or hospital outpatient. Boxed Warning makes home infusion generally inappropriate. |
| TDI not pre-authorized | Total dose infusion submitted without medical necessity letter | Submit Ganzoni calculation, TDI clinical rationale, observation protocol. TDI is off-label and many payers require explicit auth. |
| Wrong indication (ESRD/dialysis) | J1750 billed for dialysis patient | Switch to ESRD-bundled IV iron (Venofer/Feraheme) per CMS policy. INFeD is not the typical ESRD-bundle product. |
Frequently asked questions
What is the HCPCS code for INFeD?
INFeD (iron dextran low molecular weight, IV) is billed under HCPCS J1750 —
"Injection, iron dextran, 50 mg." This is the most common biller error trap on INFeD claims:
1 unit = 50 mg, NOT 1 mg. A 100 mg dose is billed as 2 units, not 100 units.
Why is INFeD's unit basis different from other IV irons?
J1750 was assigned in the early HCPCS era when iron dextran was the dominant injectable iron. Its descriptor sets 1 unit = 50 mg of elemental iron — the same as one 100 mg / 2 mL vial divided in half. By contrast, the modern IV irons (Injectafer J1439, Monoferric J1437, Venofer J1756) use 1 mg = 1 unit. Billers transitioning between products routinely overstate INFeD units by 50×.
Does INFeD require a test dose?
Yes. INFeD is the only currently marketed IV iron in the US that requires a mandatory test dose at every new course of therapy. Per the FDA label: administer 0.5 mL (25 mg) IV slowly over at least 30 seconds and observe the patient for at least 1 hour for anaphylactoid or other adverse reactions before initiating the full therapeutic dose. The test dose must be repeated at every new course, not just first lifetime exposure.
What administration CPT do I use for INFeD?
For the test dose: CPT 96374 (therapeutic IV push, single drug) is most common. For the
subsequent therapeutic dose given as IV infusion: CPT 96365 (therapeutic IV infusion up
to 1 hour); add 96366 for each additional hour for total dose infusion (TDI) protocols
that run 4–6 hours. Do not bill 96413 (chemotherapy admin) — INFeD is non-chemotherapy.
Do I bill JZ or JW for INFeD?
INFeD ships in 100 mg / 2 mL single-dose vials. JZ applies on every claim where the full vial is administered with no waste; JW applies when partial-vial waste occurs (common for the 25 mg test dose and weight-based pediatric dosing). For a standard test dose: 25 mg administered + 75 mg discarded — bill the units administered plus the JW line for the discarded portion.
What is the Medicare reimbursement for J1750?
For Q2 2026, the Medicare Part B payment limit for J1750 is $18.105 per 50 mg unit (ASP + 6%), which equals approximately $0.362 per mg of elemental iron. A 100 mg dose (one full vial) reimburses at approximately $36.21 (2 units × ASP+6%). A typical 1,000 mg cumulative course at 100 mg per session reimburses at approximately $362.10 in drug cost across 10 sessions.
Why is INFeD considered last-line in modern IV iron algorithms?
Three reasons: (1) Boxed Warning for serious hypersensitivity reactions including anaphylaxis (sometimes fatal), even after a tolerated test dose; (2) the test dose itself adds chair time, observation time, and a separate billable encounter for every new course; (3) modern non-dextran IV irons (Injectafer, Monoferric, Feraheme, Venofer) have substantially lower anaphylaxis rates and do not require a test dose.
Was DexFerrum the same as INFeD?
No. DexFerrum was a high molecular weight (HMW) iron dextran, withdrawn from the US market in 2009 after data showed substantially higher rates of anaphylaxis than the low molecular weight (LMW) iron dextran formulation. INFeD is the LMW formulation and is the only iron dextran product currently available in the US.
How does INFeD compare to other IV irons?
INFeD (J1750, iron dextran LMW, 50 mg per unit, $0.362/mg, requires test dose, Boxed Warning) is the oldest IV iron in the US market. It competes with Injectafer (J1439, ferric carboxymaltose, no test dose), Monoferric (J1437, ferric derisomaltose, single 1,000 mg dose, no test dose), Feraheme (Q0138, ferumoxytol, no test dose but Boxed Warning for hypersensitivity), and Venofer (J1756, iron sucrose, no test dose, lowest per-mg ASP among the modern products).
Reference
Sources & methodology
Every claim on this page is sourced. Methodology and review history below.
Source documents
- DailyMed — INFeD (iron dextran injection) Prescribing Information
- Allergan / AbbVie — INFeD product information
- CMS — Medicare Part B Drug ASP Pricing File
- SEER CanMED — HCPCS J1750 reference
- UnitedHealthcare — IV Iron Therapy / Medical Drug Policies
- Aetna CPB — Parenteral Iron Therapy
- FDA National Drug Code Directory
- KDIGO — Anemia in CKD Guideline
- ACG — Iron Deficiency Anemia Clinical Guideline
- FDA safety communications — iron dextran HMW (DexFerrum) market withdrawal 2009
About this page
We maintain this page as a living reference. Medicare ASP pricing is bound to our underlying CareCost data layer and refreshes automatically when CMS publishes new quarterly files. Coding and policy content is reviewed at least quarterly and updated whenever a source document changes.
Found an error? Email hello@carecostestimate.com.
Refresh cadence
| Element | Cadence | How it's refreshed |
|---|---|---|
| Medicare ASP pricing | Quarterly | Auto-bound to CareCost ASP layer; updates on CMS file release. |
| Payer policies (UHC, Aetna, BCBS) + step therapy through non-dextran IV irons | Semi-annual | Manual review against published payer policy documents. |
| HCPCS / CPT / modifier rules | Annual | Reviewed against CMS HCPCS quarterly files and AMA CPT releases. |
| NDC, dosing, FDA label, Boxed Warning, test dose protocol | Event-driven | Tied to manufacturer document version + FDA label revision date. |
| IV iron class comparison (per-mg ASP across products) | Annual | Re-priced from CMS Q2 file each year; descriptive comparison reviewed annually. |
Reviewer
Pending SME review. This page is staff-authored from primary sources (FDA, CMS,
manufacturer, payer documents — all linked above). Editorial review in progress. Until that review is complete, treat this as a draft reference and verify each
cited source for high-stakes claims — in particular, verify the J1750 unit conversion (mg
÷ 50) and the test-dose documentation requirements at billing time.
Change log
- — Initial publication. ASP data: Q2 2026. Manufacturer source: Allergan / AbbVie INFeD label. FDA label: current revision including Boxed Warning for serious hypersensitivity reactions and mandatory test dose protocol. IV iron class comparison covers INFeD / Injectafer / Monoferric / Feraheme / Venofer. DexFerrum (HMW iron dextran) historical context noted — withdrawn 2009.
Methodology
Every claim on this page is sourced inline. Pricing reflects the current CMS Part B Drug ASP Pricing File. Payer policies are read directly from each payer's published medical/pharmacy policy documents. Indication list is verified against the current FDA label revision. We do not paraphrase from billing-software vendor blogs.