HCPCS
J1756
1 billing unit = 1 mg
Venofer and the IV iron class
Venofer (iron sucrose) bills under J1756, 1 mg per billing unit, from a 100 mg elemental-iron single-dose vial. American Regent makes the reference product; five other IV iron agents compete in the same drug class under their own HCPCS codes, and none of them is a biosimilar of Venofer or of each other.
| Product | Code | Per unit | Per 1,000 mg |
|---|---|---|---|
| Ferrlecit (sodium ferric gluconate) | J2916 | $2.197 / 12.5 mg | $175.76 |
| Venofer (iron sucrose) | J1756 | $0.227 / mg | $227.00 |
| Feraheme (ferumoxytol), non-ESRD | Q0138 | $0.370 / mg | $377.40 |
| INFeD (iron dextran) | J1750 | $18.993 / 50 mg | $379.86 |
| Injectafer (ferric carboxymaltose) | J1439 | $1.132 / mg | $1,132.00 |
| Monoferric (ferric derisomaltose) | J1437 | $21.077 / 10 mg | $2,107.70 |
A 12x spread across one drug class for the same 1,000 mg of iron. Labeled courses differ — Injectafer runs 750 mg twice, Feraheme 510 mg twice, Monoferric a single 1,000 mg dose — so the number of visits and administration claims differs too, which is why the cheapest per-mg product is not automatically the cheapest full course.
This reference does not recommend one iron product over another on clinical grounds. Site protocol, formulary status and infusion-chair time drive that choice more than the per-mg rate does.
Venofer dosing
Every regimen is a fixed 1,000 mg cumulative course, not a repeating interval, and which one applies depends on the dialysis setting.
| Population | Regimen | Notes |
|---|---|---|
| Non-dialysis CKD (NDD-CKD) | 200 mg slow IV injection over 2-5 minutes, or diluted in 100 mL sodium chloride and infused over 15 minutes | Separately payable under Part B. Each dose is 2 vials and 200 billing units; the whole course is 1,000 units across 5 visits. |
| Hemodialysis CKD (HDD-CKD) | 100 mg slow IV injection over 2-5 minutes during a hemodialysis session, 1-3 sessions a week | The commonest clinical use and the commonest denial: given during in-center or home hemodialysis this sits inside the ESRD PPS bundled rate and is not separately payable to Part B. |
| Peritoneal dialysis CKD (PDD-CKD) | 300 mg IV infusion over 90 minutes for the first two doses, then 400 mg IV infusion over 2.5 hours | Separately payable under Part B. The only regimen long enough to bill an infusion code rather than a push, and the 400 mg dose is the only one that reaches a second hour. |
| Pediatric (2 years and older), hemodialysis | 0.5 mg/kg slow IV injection over 2-5 minutes per dialysis session, maximum 100 mg per dose | The only weight-based regimen, and the only routine source of discarded drug: a dose below 100 mg leaves part of a single-dose vial, which is billed on its own JW line. |
There is no open-ended maintenance schedule on the label. A course runs to 1,000 mg cumulative and stops; repeat courses are driven by ferritin, transferrin saturation and hemoglobin rather than by a calendar interval, which is why a prior authorization for Venofer is normally written per course rather than per year.
Pre-treatment documentation
- Document ferritin and transferrin saturation within the prior 90 days — most payer policies set a threshold on both.
- Document oral iron failure or intolerance for any non-CKD use; that is where prior authorization is refused most often.
- Confirm the dialysis setting before the claim is built: it decides whether the dose is payable at all.
Need the units for a patient's dose? Convert dose to J1756 billing units →
Venofer billing reference
HCPCS
J1756 bills 1 mg per unit. A 200 mg dose is 200 units; the full 1,000 mg course is 1,000 units across the visits in a regimen.
NDC
00517-2340-01 is the NDC billed on most claims. Unlike multi-component oncology cartons, IV iron is typically billed at the vial-level NDC rather than a carton NDC — confirm the payer's own format requirement before submitting.
| NDC (10-digit) | NDC (11-digit, claim form) | Package |
|---|---|---|
0517-2340-01 | 00517-2340-01 | 100 mg/5 mL single-dose vial |
0517-2340-10 | 00517-2340-10 | Same vial, packaged as a 10-vial tray |
Administration
Administration is a decision, not a fixed code: the dose and dilution decide whether it is a push or an infusion. Full code definitions live on CPT 96374–96376 and CPT 96365–96366.
| Code | When it applies for Venofer |
|---|---|
96374 | Primary code. The labeled 100 mg and 200 mg doses are a slow IV push over 2–5 minutes ($37.74, Medicare PFS national non-facility, 2026). |
96365 / 96366 | Only when the dose is diluted in 100 mL saline and infused over 15 minutes or more — the NDD-CKD infusion option, the 300 mg PDD-CKD dose (96365 alone), and the 400 mg PDD-CKD dose, which adds 96366 for the second hour. |
96375 | Each additional sequential push of a different drug. Rarely relevant to Venofer monotherapy. |
96413 | Not appropriate. Iron sucrose is not chemotherapy. |
Modifiers
JZ — required when no drug is discarded. JW — required for documented waste.
The 200 mg, 100 mg and 300 mg doses each draw whole 100 mg vials with nothing left over, so JZ is the norm on the adult regimens. The pediatric 0.5 mg/kg dose, capped at 100 mg, is the only routine case that leaves part of a vial unused and generates a JW line.
Full unit, vial and modifier math for any dose: calculate Venofer billing units →
Claim form
CMS-1500 / 837P field map for a separately payable J1756 claim.
| Information | CMS-1500 box | Notes |
|---|---|---|
| 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) |
| HCPCS J1756 + JZ (or JW for pediatric waste) | 24D (drug line) | JZ on virtually every adult claim |
| Drug units | 24G | Dose in mg, since 1 mg = 1 unit |
| CPT 96374 (or 96365/96366) | 24D (admin line) | Matches the dose actually given — push vs. diluted infusion |
| ICD-10 | 21 | D63.1 primary or secondary; see Coverage |
| Dialysis setting | documentation, not a claim box | Confirm in the chart before billing — it decides whether this claim should exist at all |
Venofer coverage and the ESRD PPS bundling rule
Under the Medicare ESRD Prospective Payment System, in force since January 1, 2011, the dialysis facility is paid one bundled per-treatment rate that covers renal-related items including IV iron.
| Setting | Separately payable to Part B? |
|---|---|
| HDD-CKD, in-center hemodialysis, dose given during dialysis | No — bundled in the ESRD PPS |
| HDD-CKD, home hemodialysis, administered by the dialysis vendor | No — bundled |
| NDD-CKD, physician office (POS 11) | Yes |
| PDD-CKD, scheduled infusion at office or HOPD (POS 11/22) | Yes |
| Non-CKD iron-deficiency anemia (off-label), any setting | Yes, with prior authorization |
The 100 mg hemodialysis dose is the commonest clinical use of this drug and the one that cannot be billed separately, which is why the estimator defaults to the 200 mg NDD-CKD dose instead.
- CareCost's payer-policy library carries no iron sucrose coverage corpus yet — use the ESRD PPS rule and the diagnosis table below, plus the payer's own policy, for a live prior authorization.
- 37 commercial payers carry J1756 rates in this site's commercial rate data; that is separate from a Clearance-indexed prior-authorization policy, which does not yet exist for iron sucrose.
ICD-10-CM by indication
Verified against the NLM Clinical Table Search Service on 2026-09-12. Use the most specific code supported by chart documentation.
| Code | Description | Notes |
|---|---|---|
D63.1 | Anemia in chronic kidney disease | The load-bearing code. Payer policies want it as primary or secondary; a CKD stage code alone triggers denial. |
N18.4 | CKD stage 4 (severe) | |
N18.5 | CKD stage 5 | |
N18.6 | End stage renal disease | Pairs with Z99.2 for dialysis patients |
Z99.2 | Dependence on renal dialysis | Secondary code alongside N18.6 |
D50.0 / D50.8 / D50.9 | Iron-deficiency anemia | The off-label, non-CKD uses |
N18.3 is not billable. CKD stage 3 requires a subcode:
N18.30 (unspecified), N18.31 (3a) or N18.32 (3b).
Full FDA-indicated Medicare reference: Medicare covered diagnoses for Venofer →
Venofer pricing
Medicare ASP+6%: $0.227 / 1 mg · $45.40 / 200 mg. Administration (96374) allows $37.74 more, so the default reference claim — a 200 mg NDD-CKD dose plus 96374 — allows $83.14 total, 45% of it administration.
At 20% coinsurance with the $283 Part B deductible already met, the patient owes $16.63 of that claim. Commercial plans pay a contracted rate that varies by payer and state; see the IV iron class comparison above for how Venofer's own rate sits against five alternative agents.
| Quarter | 2025 Q1 | Q2 | Q3 | Q4 | 2026 Q1 | Q2 | Q3 |
|---|---|---|---|---|---|---|---|
| $ / mg | $0.226 | $0.237 | $0.224 | $0.229 | $0.236 | $0.223 | $0.227 |
Look up commercial reimbursement →
Patient cost
Patient responsibility = payer allowed rate − benefits adjustment − assistance. Because administration is a much larger share of this claim than on other drugs in this reference, an unbilled or downcoded 96374 line changes the patient's share by a larger fraction here.
Calculate a Venofer patient estimate →
Copay & financial assistance
American Regent runs one open program for Venofer: AR Assist, a free-drug program for uninsured patients at or under 400% of the federal poverty level. It ships the drug directly to the provider and does not cover administration or the office visit.
Common Venofer denials & fixes
| Denial reason | Common cause | Fix |
|---|---|---|
| Hemodialysis dose billed to Part B | 100 mg HDD-CKD dose submitted as a standalone J1756 claim | Confirm the drug was given during dialysis — it is bundled into the ESRD PPS facility rate and is not separately billable. Bill only the NDD-CKD, PDD-CKD or non-CKD regimens to Part B. |
| Wrong administration code (96365 on a push dose) | Therapeutic infusion code used out of habit | Resubmit with 96374 unless the dose was actually diluted and infused over 15 minutes or more. |
| 96413 billed | Chemotherapy infusion code applied to an iron product | Resubmit with 96374, or 96365/96366 if infused — iron sucrose is not chemotherapy. |
| N18.3 submitted | Unspecified stage 3 CKD code used, which is not billable | Resubmit with N18.30, N18.31 or N18.32. |
| JZ missing | Single-dose-vial claim submitted without JZ when no drug was discarded | Resubmit with JZ — the norm on the 200 mg, 100 mg and 300 mg doses. |
| Underpriced or missing administration line | 96374 not billed, or billed at $0 | Confirm the admin line is present at $37.74 — 45% of the default claim's allowed amount, not a rounding error. |
Frequently asked questions
What is the dosing for iron sucrose by indication?
Dosing depends on the dialysis setting, and each regimen is a fixed 1,000 mg cumulative course rather than an ongoing interval:
- Non-dialysis CKD = 200 mg on 5 different days over about 14 days, to 1,000 mg cumulative
- Hemodialysis-dependent CKD = 100 mg during consecutive dialysis sessions, to 1,000 mg cumulative
- Peritoneal-dialysis-dependent CKD = 300 mg twice 14 days apart, then 400 mg 14 days later, to 1,000 mg cumulative
- Children 2 years and older on hemodialysis = 0.5 mg/kg, capped at 100 mg, once a week for up to 12 weeks
Which setting a patient is in also decides whether any of this is billable to Part B at all — see the ESRD PPS rule above.
Is Venofer given during hemodialysis billable to Medicare Part B?
No. Since January 1, 2011, the ESRD Prospective Payment System bundles IV iron into the dialysis facility's per-treatment rate, so the 100 mg hemodialysis dose — the commonest use of this drug — is not separately payable to Part B. Non-dialysis CKD (NDD-CKD) and peritoneal-dialysis CKD (PDD-CKD) doses are separately payable; so is non-CKD iron-deficiency anemia, with prior authorization.
What administration code applies to a Venofer injection?
96374, IV push, for the labeled 100 mg and 200 mg doses given as a slow injection over 2 to 5 minutes. 96365 applies only when the dose is diluted in saline and infused over 15 minutes or more, which covers the NDD-CKD infusion option and the 300 mg PDD-CKD dose; 96366 pairs with it for the 400 mg PDD-CKD dose that runs 2.5 hours. 96413, the chemotherapy infusion code, does not apply — iron sucrose is not chemotherapy.
Why does administration cost so much of the Venofer claim?
Administration (96374) allows $37.74 against $45.40 for the 200 mg drug dose — 45% of the claim, not the low single digits typical of other drugs on this site. An unbilled or downcoded administration line costs proportionally more here than on a drug where the medication itself dominates the bill. Site of care matters as much as the drug's own rate does.
How does Venofer compare to other IV iron products?
Per 1,000 mg of elemental iron at Q3 2026 Medicare rates, Ferrlecit runs $175.76, Venofer $227.00, Feraheme $377.40, INFeD $379.86, Injectafer $1,132.00 and Monoferric $2,107.70 — a 12x spread inside one drug class. The labeled courses differ in dose count and visits, so the cheapest per-mg product is not automatically the cheapest full course. This reference does not recommend one iron product over another on clinical grounds.
Sources
- DailyMed — VENOFER (iron sucrose) Prescribing Information
- American Regent — Venofer product page
- CMS — Medicare Part B Drug ASP Pricing File
- CMS — ESRD Prospective Payment System
- NLM Clinical Table Search Service — ICD-10-CM lookup
- FDA National Drug Code Directory
Dataset dates: pricing Q3 2026 · assistance Jun 2026.
Reviewed September 12, 2026 by Erin Rose, CareCost Estimate founder. Methodology →