HCPCS
J1756
1 mg = 1 unit
Phase 1
Identify what you're billing
Confirm setting (HD bundle vs Part B), dose, and which IV iron is right for the patient.
IV iron class comparison CMS Q2 2026 ASP
Five IV irons billed under Medicare Part B. Venofer is the lowest per-mg but requires the most visits.
| Product | HCPCS | Generic | Per-dose | ASP+6% | Doses to 1,000 mg | Boxed? |
|---|---|---|---|---|---|---|
| Venofer | J1756 | iron sucrose | 100–300 mg | $0.223/mg | 5–10 | No |
| Injectafer | J1439 | ferric carboxymaltose | 750 mg × 2 | $1.103/mg | 2 (1,500 mg) | No |
| Monoferric | J1437 | ferric derisomaltose | 1,000 mg × 1 | ~$1.05/mg | 1 | No |
| Feraheme | Q0138 / Q0139 | ferumoxytol | 510 mg × 2 | ~$0.93/mg | 2 (1,020 mg) | Yes (anaphylaxis) |
| INFeD | J1750 | iron dextran | 100 mg / TDI | ~$0.85/mg | 10 (or single TDI infusion) | Yes (test dose required) |
Why Venofer wins for HDD-CKD: dialysis patients are at the chair 3×/week anyway.
Venofer's 100 mg slow IV push during dialysis adds zero visit burden. The lower per-mg ASP makes it the
economic default for dialysis chains. NDD-CKD and non-CKD IDA patients have a much harder choice —
Injectafer or Monoferric save 3–9 office visits at higher per-mg cost.
HDD vs NDD vs PDD-CKD dosing matrix FDA label verified
Three completely different dosing schemas based on dialysis status. Confirm which applies before submitting PA.
| CKD setting | Per-dose | Schedule | Cumulative | Admin | Billing |
|---|---|---|---|---|---|
| HDD-CKD in-center hemodialysis |
100 mg | 1–3× per week during dialysis (typically 10 consecutive sessions) | 1,000 mg + maintenance per labs | Slow IV push 2–5 min | ESRD PPS bundled — not separately Part B |
| NDD-CKD non-dialysis |
200 mg | 5 different days over ~14 days | 1,000 mg | Slow IV injection over 2–5 min OR 15-min infusion | Part B separately billable (J1756) |
| PDD-CKD peritoneal dialysis |
300 mg ×2 + 400 mg ×1 | 2 doses 14 days apart, then 400 mg dose 14 days later | 1,000 mg | IV infusion: 90 min (300 mg) / 2.5 hr (400 mg) | Part B separately billable (J1756) |
| Pediatric ≥2 yr HDD | 0.5 mg/kg, max 100 mg | Per HD session, weekly × 12 wk | Per labs | Slow IV push 2–5 min | ESRD PPS bundled if dialysis-acquired |
Off-label IDA (non-CKD): Common for heavy menstrual bleeding, post-bariatric, IBD-associated
anemia. Not FDA-approved. Most payers will require ferritin <100 ng/mL or TSAT <20% plus a documented
oral iron failure or intolerance. Some prefer Injectafer / Monoferric for non-CKD because of single-dose
convenience — verify formulary preference before starting Venofer for non-CKD IDA.
Dosing & unit math FDA label verified
From FDA prescribing information (Venofer, American Regent).
Hemodialysis-dependent CKD (HDD-CKD) — the workhorse use
- 100 mg slow IV push over 2–5 minutes during a hemodialysis session
- 1–3 sessions per week; typical induction = 10 consecutive HD sessions to reach 1,000 mg cumulative
- Maintenance per Hgb / ferritin / TSAT — many patients receive ongoing 100 mg every 1–2 weeks
- Each dose = 1 vial (100 mg / 5 mL). 1 mg = 1 unit → bill 100 units per dose
- Critical: ESRD PPS bundled when given during in-center HD — not separately Part B
Non-dialysis-dependent CKD (NDD-CKD)
- 200 mg IV on 5 different days over a ~14-day period (cumulative 1,000 mg)
- Each dose may be slow IV injection (over 2–5 min undiluted) or IV infusion in 100 mL NaCl over 15 min
- Each dose = 2 vials (200 mg). Bill 200 units per dose
- Five-dose regimen total: 1,000 units across 5 visits
- Separately billable Part B (J1756) — not bundled
Peritoneal dialysis-dependent CKD (PDD-CKD)
- Dose 1 (Day 0): 300 mg IV infusion over 90 min (3 vials → 300 units)
- Dose 2 (Day 14): 300 mg IV infusion over 90 min (3 vials → 300 units)
- Dose 3 (Day 28): 400 mg IV infusion over 2.5 hours (4 vials → 400 units)
- Cumulative 1,000 mg across 3 visits
Pediatric (≥2 yr) HDD-CKD
- 0.5 mg/kg per HD session, weekly, for up to 12 weeks (max 100 mg per dose)
- Bill the actual mg administered (not rounded)
- Pediatric dosing always produces partial-vial waste → JW modifier applies on the wasted portion
Worked example — NDD-CKD 1,000 mg induction (Part B billable)
# Per dose (200 mg)
Drug units billed: 200 (J1756 with JZ)
Vials: 2 × 100 mg single-dose
Admin: 96374 (IV push) or 96365 (15-min infusion) — choose by actual technique
# 5-dose induction course
Total visits: 5
Total drug units: 1,000 (5 × 200)
Total drug cost (Q2 2026 ASP+6%): ~$223
Plus 5 admin visits: ~$80–120 (96374 or 96365 + facility)
Drug units billed: 200 (J1756 with JZ)
Vials: 2 × 100 mg single-dose
Admin: 96374 (IV push) or 96365 (15-min infusion) — choose by actual technique
# 5-dose induction course
Total visits: 5
Total drug units: 1,000 (5 × 200)
Total drug cost (Q2 2026 ASP+6%): ~$223
Plus 5 admin visits: ~$80–120 (96374 or 96365 + facility)
Worked example — HDD-CKD induction (ESRD PPS bundled)
# Per dose (100 mg) during HD
Drug units administered: 100 (J1756)
Vials: 1 × 100 mg single-dose
# BILLING: NOT separately billed to Part B
Payment is part of the per-treatment ESRD PPS bundle paid to the dialysis facility
# DOCUMENTATION: Still document NDC, dose, and administration time for facility records and quality reporting
Drug units administered: 100 (J1756)
Vials: 1 × 100 mg single-dose
# BILLING: NOT separately billed to Part B
Payment is part of the per-treatment ESRD PPS bundle paid to the dialysis facility
# DOCUMENTATION: Still document NDC, dose, and administration time for facility records and quality reporting
Hgb / iron monitoring
Per KDIGO + KDOQI CKD anemia guidelines: hold IV iron when ferritin >500 ng/mL or TSAT >30%; resume when both fall below thresholds and Hgb <target. Document baseline and re-check ferritin/TSAT before each induction course. Payer PA criteria typically mirror these thresholds.
NDC reference FDA NDC Directory verified May 2026
| NDC (10/11-digit) | Package | Use |
|---|---|---|
0517-2340-01 / 00517-2340-01 |
100 mg / 5 mL single-dose vial — 1 vial per carton | Standard institutional and HD use |
0517-2340-10 / 00517-2340-10 |
100 mg / 5 mL single-dose vial — 10-vial tray | Dialysis facility / infusion suite bulk |
Use vial-level NDC for IV iron claims. Unlike multi-component oncology cartons, IV irons
are typically billed at the vial NDC. Confirm payer-specific NDC requirement — some payers want the
outer carton NDC, others the vial. American Regent's billing guide lists
00517-2340-01 for
most claim contexts.
Storage & handling: Store at 25°C (77°F); excursions permitted 15–30°C.
Do not freeze. Single-dose vials — discard unused portion. 100 mg/5 mL = 20 mg/mL elemental iron.
Phase 2
Code the claim
96374 (IV push) is correct for slow-injection administration. ESRD PPS rules override Part B in HD setting.
Administration codes CPT verified May 2026
Venofer is given as IV push or short infusion — the right CPT depends on actual administration technique.
| Code | Description | When to use |
|---|---|---|
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance/drug); intravenous push, single or initial substance/drug | Primary code for Venofer slow IV push. Standard 100–200 mg dose given over 2–5 minutes (or up to 15 min undiluted) is push, not infusion. |
96365 |
Intravenous infusion, for therapy/prophylaxis/diagnosis; initial, up to 1 hour | Use when Venofer is diluted in 100 mL NaCl and infused over 15 min (NDD-CKD option) or for 300 mg PDD dose over 90 min. |
96366 |
IV infusion; each additional hour | For 400 mg PDD-CKD dose infused over 2.5 hours — pair with 96365 for the second hour. |
96375 |
Each additional sequential IV push of a new substance/drug | Rarely needed for Venofer monotherapy. Use if a separate IV push drug is given the same encounter. |
96413 |
Chemotherapy IV infusion | NOT appropriate. Iron sucrose is not chemotherapy. Use 96374 or 96365. |
Why 96374, not 96365: The FDA label specifies slow IV injection for the most common
Venofer use (100 mg HDD and 200 mg NDD doses). When given undiluted over 2–5 minutes, the
administration is by definition an IV push (96374), not an infusion. 96365 only applies when the drug is
diluted and run over 15+ minutes via a programmed infusion.
HDD-CKD setting reminder: When Venofer is given during in-center hemodialysis, the admin
code is part of the ESRD PPS bundle — you typically do not bill 96374 separately.
Admin codes apply only when Venofer is billed under Part B (NDD-CKD office visits, PDD-CKD scheduled
infusions, off-label IDA in non-dialysis settings).
Modifiers CMS verified May 2026
JZ — required on virtually every adult Venofer claim
Effective July 1, 2023, CMS requires the JZ modifier on all single-dose container claims when no drug is discarded. Venofer's 100 mg/5 mL single-dose vial is used as a whole-vial dose — 100 mg = 1 vial, 200 mg = 2 vials, 300 mg = 3 vials, 400 mg = 4 vials. Adult fixed-dose regimens produce zero waste. JZ applies to virtually every adult J1756 Part-B claim.
JW — pediatric weight-based dosing only
JW reports the discarded portion of a single-dose vial. For Venofer, JW only applies to pediatric weight-based dosing where partial-vial waste occurs. Example: a 20 kg child receiving 10 mg (0.5 mg/kg) uses one 100 mg vial and discards 90 mg — bill JW with 90 units of waste on a separate claim line. One of JZ or JW must be on every J1756 claim.
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 IV iron infusion (e.g., baseline anemia work-up at first visit). Routine pre-infusion vitals are bundled.
340B modifiers (JG, TB)
For 340B-acquired Venofer, follow your MAC's current 340B modifier policy. American Regent's billing materials do not provide 340B-specific instructions; defer to MAC and 340B program manual.
ICD-10-CM by CKD setting FY2026 verified May 2026
ICD-10 selection drives PA approval. Pair the CKD stage code with the iron-deficiency anemia code.
| Setting | Primary ICD-10 | Required pair | Notes |
|---|---|---|---|
| HDD-CKD (in-center HD) | N18.6 (ESRD / CKD stage 5) |
D63.1 (anemia of CKD) + Z99.2 (dialysis dependence) |
Triple-code combination; Z99.2 documents dialysis status for ESRD PPS |
| NDD-CKD | N18.3–N18.5 (CKD stages 3a/3b/4) |
D63.1 (anemia of CKD) |
Use most specific stage; D63.1 is required pair for IV iron PA |
| PDD-CKD | N18.6 (CKD stage 5) |
D63.1 + Z99.2 |
Same trio as HDD; PD scheduling differs but coding is similar |
| Off-label IDA (non-CKD) | D50.0 (chronic blood-loss IDA), D50.8, D50.9 |
Underlying cause: N92.x HMB, K50/K51 IBD, etc. |
Higher PA scrutiny; document oral-iron failure |
| Pediatric (≥2 yr) CKD | N18.x (per stage) |
D63.1 |
Use age-appropriate documentation; pediatric anemia thresholds differ |
D63.1 is the load-bearing code for IV iron in CKD. Most payer LCDs and medical policies
require
D63.1 (anemia in chronic kidney disease) as a primary or secondary diagnosis. Submitting
only the CKD stage code without D63.1 will trigger denial — even if the patient clearly has anemia.
Lab thresholds in PA criteria: Most payers require ferritin <500 ng/mL AND TSAT <30%
documented in the prior 90 days. Some plans require ferritin <100 ng/mL or TSAT <20% for non-CKD IDA.
Schedule labs at baseline and 4–8 weeks after induction.
Site of care & place of service Verified May 2026
Site of care is uniquely complicated for Venofer because of the ESRD PPS bundle. Most other Part B drugs have payer site-of-care UM steering away from HOPD; Venofer has Medicare regulatory steering INTO the dialysis facility's bundled payment when given during HD.
| Setting | POS | Claim form | Billing path |
|---|---|---|---|
| In-center HD facility | 65 (ESRD) | UB-04 / 837I | ESRD PPS bundled — per-treatment payment to facility; J1756 NOT separately billed |
| Physician office (NDD-CKD) | 11 | CMS-1500 / 837P | Part B separately billable (J1756 + 96374/96365) |
| Nephrology infusion suite | 11 / 49 | CMS-1500 / 837P | Part B separately billable |
| Hospital outpatient (PDD-CKD) | 22 / 19 | UB-04 / 837I | Part B billable; some payers steer to office |
| Patient home (rare) | 12 | CMS-1500 (home infusion) | Possible for NDD with home-infusion vendor; verify payer |
Setting drives everything: the same 100 mg dose given to the same patient on the same day
is billed completely differently depending on whether it's during in-center HD (bundled) or in a
non-dialysis nephrology office (Part B). Document POS carefully and verify with the dialysis facility's
billing department before submitting.
Claim form field mapping May 2026
For Part B-billable Venofer (NDD-CKD office, PDD-CKD scheduled infusion).
| Information | CMS-1500 box | Notes |
|---|---|---|
| NPI | 17b | Rendering provider |
| NDC qualifier + 11-digit NDC + UoM + qty | 24A shaded area | N4 + 00517-2340-01 + ML + total volume (5 mL for 100 mg, 10 mL for 200 mg, 15 mL for 300 mg) |
| HCPCS J1756 + JZ (or JW for pediatric waste) | 24D (drug line) | Mark JZ on virtually every adult claim |
| Drug units | 24G | 100 / 200 / 300 / 400 (= mg administered) |
| CPT 96374 or 96365 (admin line) | 24D (admin line) | 96374 push (most common); 96365 if 15-min+ infusion |
| ICD-10 | 21 | N18.x + D63.1 (+ Z99.2 if dialysis) |
| PA number | 23 | Required for off-label IDA; many CKD claims do not require PA |
HDD-CKD bundled claims: The dialysis facility submits a UB-04 with the per-treatment
ESRD PPS revenue code (082x family). J1756 is NOT a separate line item billed to Part B in that scenario.
Verify with your dialysis-facility billing manual — the bundled drug list and PPS rules govern.
Phase 3
Get paid
ESRD PPS bundling is the #1 reason J1756 claims are denied as duplicates.
ESRD PPS bundled payment — the load-bearing rule for J1756 CMS PPS verified May 2026
More denials are written for J1756 over PPS bundling than for any other reason. Get this right.
The Medicare End-Stage Renal Disease Prospective Payment System (ESRD PPS) was implemented January 1, 2011. Under PPS, Medicare pays the dialysis facility a single bundled per-treatment rate that covers all renal-related items and services, including ESAs (epoetin, darbepoetin), IV iron (including Venofer), vitamin D analogs, and laboratory tests.
What's bundled vs separately billable
| Scenario | Setting | J1756 billable to Part B? |
|---|---|---|
| HDD-CKD patient, in-center HD, Venofer during dialysis | POS 65 | NO — bundled in PPS |
| HDD-CKD patient, home HD, Venofer during HD | Home (POS 12) administered by HD vendor | NO — bundled in PPS |
| NDD-CKD patient, physician office Venofer | POS 11 | YES — separately Part B |
| PDD-CKD patient, scheduled infusion at HOPD/office | POS 11/22 | YES — separately Part B |
| HDD-CKD patient, separately scheduled non-dialysis Venofer (rare) | POS 11 | Possible but heavily scrutinized; document medical necessity for non-bundled administration |
| Off-label IDA (non-CKD), any setting | POS 11/22 | YES — separately Part B (with PA) |
The classic denial: Office tries to bill J1756 to Part B for a patient who received
Venofer during in-center hemodialysis on the same date the dialysis facility billed the per-treatment
bundle. Medicare denies as already-paid via the bundle. Fix: confirm setting before submitting; coordinate
with the dialysis facility billing team; only submit Part B claims for genuinely non-bundled administrations.
Acute Kidney Injury (AKI) exception
Effective January 1, 2017, dialysis facilities can bill Medicare for furnishing renal dialysis services to AKI patients. AKI dialysis (limited duration, expected renal recovery) is paid under the ESRD PPS base rate but with different drug-bundling rules — some drugs that are bundled for ESRD are separately billable for AKI. Verify current AKI bundling list before billing.
Documentation expectation regardless of bundling
Even when Venofer is bundled (not separately billed), the dialysis facility must document NDC, dose, lot number, administration time, and ferritin/TSAT values for: ESRD QIP quality reporting, MIPS for nephrology practices, internal pharmacy P&T tracking, and audit defense. Don't skip documentation just because the claim isn't itemized.
Payer policy snapshot Reviewed May 2026
UHC and other major payers have IV iron LCDs covering Venofer for CKD anemia with documented iron deficiency.
| Payer | PA? | Lab thresholds | Off-label IDA |
|---|---|---|---|
| UnitedHealthcare IV Iron Therapy Medical Policy |
For NDD-CKD: typically not required when LCD criteria met; off-label IDA: YES | Ferritin <500 ng/mL + TSAT <30% (CKD); <100/<20% (non-CKD) | Yes — PA required; oral iron failure documented |
| Aetna CPB IV Iron Therapy |
Generally not for CKD anemia; YES for non-CKD IDA | Same KDIGO/KDOQI-aligned thresholds | Yes — oral iron trial 1–3 months required for most non-CKD IDA |
| BCBS plans Vary by plan |
Plan-specific | Generally aligned with NCCN and KDOQI guidelines | Plan-specific PA |
| Medicare MACs LCDs vary |
No NCD; coverage via LCD + PPS rules | Per LCD; D63.1 + N18.x required | D50.x with documentation |
Step therapy
Oral iron failure is the most common step requirement for non-CKD IDA. CKD anemia typically does not require oral iron failure given CKD-specific guidelines. Some payers may require trial of a less expensive IV iron before approving Injectafer or Monoferric — Venofer is often the first-line preferred IV iron precisely because it is the cheapest per mg.
Medicare reimbursement CMS Q2 2026 (live)
Quarterly ASP from CMS Part B Drug Pricing File. Refreshes automatically each quarter. Note: PPS-bundled doses do not use this rate.
Q2 2026 payment snapshot — J1756 (separately Part B)
Effective April 1 – June 30, 2026 · Based on 4Q25 ASP submissions
ASP + 6%
$0.223
per mg / per unit
100 mg dose (HDD)
$22.30
100 units × ASP+6%
200 mg dose (NDD)
$44.60
200 units × ASP+6%
1,000 mg cumulative course (Part B): 5 doses × 200 mg = ~$223 in drug
(NDD-CKD); 10 doses × 100 mg = ~$223 in drug (theoretical Part B HDD — almost
always bundled instead). Sequestration (~2%) reduces actual paid to roughly ASP + 4.3%.
HDD-CKD does not pay per-mg ASP. When Venofer is given during in-center hemodialysis, the
facility receives the ESRD PPS per-treatment composite rate (~$269 base rate for 2026, before adjustments)
— this covers ALL bundled items including Venofer, ESAs, vitamin D, labs. Do not annualize ASP×mg
for HDD patients; use PPS economics instead.
Coverage
No NCD specific to iron sucrose. Coverage falls under MAC LCDs for IV iron + the ESRD PPS bundling rules. All MACs cover J1756 for FDA-approved CKD anemia with appropriate ICD-10 (N18.x + D63.1) and lab documentation, in non-bundled settings.
Code history
- J1756 — permanent code, "Iron sucrose injection, 1 mg" — effective for years prior to ESRD PPS implementation; most recent payment-rate updates quarterly per ASP file
Patient assistance — American Regent May 2026
- American Regent Patient Assistance Program / Venofer Co-pay Program: 1-877-444-2666
- Venofer copay assistance: commercial copay support; eligible commercially-insured patients (excludes Medicare, Medicaid, federal program patients per anti-kickback rules)
- Patient Assistance (PAP): free product for uninsured / underinsured CKD patients meeting income requirements
- Foundations for Medicare CKD patients: PAN Foundation, HealthWell, NeedyMeds — verify open kidney/CKD anemia funds quarterly (these funds open and close based on availability)
- Web: venofer.com · americanregent.com
Need to model what a specific patient will actually pay after copay assistance, deductible, coinsurance,
and OOP max? Run a CareCost Estimate — J1756 pre-loaded.
Phase 4
Fix problems
PPS bundling, wrong admin code, and missing D63.1 are the top three denial reasons.
Common denials & how to fix them
| Denial reason | Common cause | Fix |
|---|---|---|
| Already paid via ESRD PPS bundle | Office billed J1756 to Part B for an HDD-CKD patient who received Venofer during in-center HD same date | Withdraw the Part B claim. Coordinate with dialysis facility billing. Do not rebill. |
| D63.1 not documented | ICD-10 has only the CKD stage code (N18.x) without the anemia-of-CKD code | Resubmit with N18.x + D63.1 paired. D63.1 is the load-bearing diagnosis for IV iron coverage. |
| Wrong admin code (96413) | Chemotherapy admin billed for non-chemo iron sucrose | Resubmit with 96374 (push) or 96365 (15-min infusion). Iron sucrose is not chemo. |
| JZ missing on adult claim | Single-dose vial claim without JZ modifier | Resubmit with JZ. Required since 7/1/2023 on every claim with no waste. |
| Pediatric JW missing | Wasted drug not reported on pediatric weight-based dose | Add JW line for discarded units. JZ on the administered units; JW on the wasted units. |
| Lab thresholds not documented | PA submitted without ferritin/TSAT in prior 90 days | Submit recent labs. Most payers want ferritin <500 + TSAT <30% for CKD; <100/<20% for non-CKD. |
| Off-label IDA without oral-iron failure | D50.x claim without documented oral iron trial | Submit chart notes showing 1–3 month oral iron trial, GI intolerance, or contraindication. |
| Wrong NDC format | Wrong package NDC submitted | Use vial-level NDC 00517-2340-01 for most claims; verify payer-specific format. |
Frequently asked questions
What is the HCPCS code for Venofer?
Venofer (iron sucrose) is billed under HCPCS J1756 — "Injection, iron sucrose, 1 mg."
Each milligram of elemental iron equals one billable unit. So 100 mg = 100 units, 200 mg = 200 units, 300 mg
= 300 units. The vial is labeled 100 mg/5 mL (20 mg/mL elemental iron). J1756 has been a permanent HCPCS
code for years and is the workhorse IV iron J-code for hemodialysis-dependent CKD anemia.
Is Venofer billed under Medicare Part B in hemodialysis patients?
No — for in-center hemodialysis-dependent CKD (HDD-CKD) patients, Venofer given during dialysis is bundled into the ESRD Prospective Payment System (PPS) per-treatment payment. The dialysis facility receives the bundled per-treatment amount and Venofer is NOT separately billable to Part B in that setting. Only NDD-CKD use (physician office), PDD-CKD scheduled infusions outside the bundle, and off-label IDA in non-dialysis settings are separately billable Part B. Always confirm setting and the dialysis facility's billing protocol before submitting a J1756 claim.
What is the dosing for Venofer?
Dosing depends on CKD stage. HDD-CKD: 100 mg slow IV push 1–3 times per week during dialysis until cumulative 1,000 mg, then maintenance per labs. NDD-CKD: 200 mg IV × 5 doses on different days over ~14 days (cumulative 1,000 mg). PDD-CKD: 300 mg IV × 2 doses + 400 mg × 1 (cumulative 1,000 mg). Pediatric (≥2 yr) HDD-CKD: 0.5 mg/kg IV per session, max 100 mg.
What administration CPT do I use for Venofer?
CPT 96374 — "Therapeutic IV push, single or initial substance/drug." This applies when
Venofer is given as the standard slow IV push (2–5 minutes). Some facilities elect to dilute and
infuse Venofer over 15 minutes, in which case 96365 (therapeutic IV infusion, up to 1 hour)
applies. Choose the code that matches actual administration technique. Do NOT bill 96413 — iron
sucrose is not chemotherapy.
Do I bill JZ or JW for Venofer?
Bill JZ on virtually every adult Venofer claim. The 100 mg/5 mL single-dose vial is used as a
whole-vial dose (100 mg = 1 vial, 200 mg = 2 vials, 300 mg = 3 vials, 400 mg = 4 vials) with zero waste in
adult fixed-dose regimens. JW only applies to pediatric weight-based dosing where partial-vial
waste occurs. One of JZ or JW must be on every J1756 claim per CMS's July 2023 single-dose container policy.
What is the Medicare reimbursement for J1756?
For Q2 2026, the Medicare Part B payment limit for J1756 is $0.223 per mg (ASP + 6%). The standard 100 mg HDD-CKD dose reimburses at approximately $22.30 per session (when separately billable in NDD setting); 200 mg NDD-CKD dose at approximately $44.60; 300 mg PDD-CKD dose at approximately $66.90. Cumulative 1,000 mg course: ~$223 in drug cost. Sequestration (~2%) reduces actual paid to roughly ASP + 4.3%. Note: HDD-CKD use is bundled into ESRD PPS, NOT paid per-mg.
How does Venofer compare to other IV irons?
Venofer (J1756, iron sucrose, $0.223/mg) is the IV iron workhorse for HDD-CKD because it can be given as a slow IV push during a dialysis session. Trade-off: it requires multiple visits (typically 5–10 doses) to reach a therapeutic 1,000 mg. Single-dose competitors include Injectafer (J1439, ferric carboxymaltose, 750 mg × 2 doses, $1.103/mg) and Monoferric (J1437, ferric derisomaltose, 1,000 mg single-dose, ~$1.05/mg) — higher per-mg cost but fewer infusion visits. Feraheme (Q0138/Q0139, 510 mg × 2, Boxed Warning) and INFeD (J1750, requires test dose) round out the class.
What are the indications for Venofer?
Venofer is FDA-approved for the treatment of iron-deficiency anemia (IDA) in adult and pediatric (≥2 yr) patients with chronic kidney disease, including hemodialysis-dependent (HDD-CKD), non-dialysis-dependent (NDD-CKD), and peritoneal dialysis-dependent (PDD-CKD). Off-label use for non-CKD IDA (e.g., heavy menstrual bleeding, post-bariatric, IBD-associated anemia) is common but not FDA-approved — these claims face higher prior-auth scrutiny and may require ferritin/TSAT documentation supporting iron deficiency.
Reference
Sources & methodology
Every claim on this page is sourced. Methodology and review history below.
Source documents
- DailyMed — VENOFER (iron sucrose) Prescribing Information
- American Regent — Venofer product page
- CMS — Medicare Part B Drug ASP Pricing File
- CMS — ESRD Prospective Payment System
- KDIGO — Anemia in CKD Guideline
- NKF KDOQI — CKD Anemia Commentary
- UnitedHealthcare — IV Iron Therapy Medical Policy
- Aetna CPB — Parenteral Iron Therapy
- FDA National Drug Code Directory
- SEER CanMED — HCPCS J1756 reference
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. |
| ESRD PPS rules | Annual | Reviewed against CMS ESRD PPS Final Rule each calendar year. |
| Payer policies (UHC, Aetna, BCBS) | Semi-annual | Manual review against published payer policy documents. |
| HCPCS / CPT / modifier rules | Annual | Reviewed against CMS HCPCS quarterly files, AMA CPT releases. |
| NDC, dosing, FDA label | Event-driven | Tied to manufacturer document version + FDA label revision date. |
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 — especially the ESRD PPS bundling determination for any specific patient.
Change log
- — Initial publication. ASP data: Q2 2026 ($0.223/mg). Manufacturer source: American Regent product page + DailyMed label. ESRD PPS bundling per CMS PPS Final Rule. KDIGO/KDOQI alignment for lab thresholds.
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. ESRD PPS bundling rules are read from the CMS ESRD PPS Final Rule and updated annually. We do not paraphrase from billing-software vendor blogs.