Is INFeD covered by Medicare?

Yes. INFeD (J1750) is covered under Medicare Part B as a physician-administered drug when billed for a medically necessary indication. There is no drug-specific Local Coverage Determination (LCD) for it, so coverage is determined per medical necessity by your MAC; the FDA-approved indications below are the starting point. None of the 8 Medicare Administrative Contractors lists J1750 as self-administered.

What diagnoses are covered for INFeD (J1750)?

Medicare publishes no drug-specific covered-diagnosis list for J1750. The 3 ICD-10 codes here are the FDA-approved indications; an off-label use needs approved-compendium support (DrugDex, NCCN) to be payable.

Which Medicare policy covers INFeD?

No drug-specific LCD or Billing & Coding Article exists for INFeD. It's covered under the general Medicare Part B drug benefit per medical necessity, as judged by your Medicare Administrative Contractor (MAC).

Why was my INFeD claim denied as not medically necessary?

The most common cause is a diagnosis the MAC doesn't consider medically necessary for J1750. Bill a covered/FDA-approved indication from the list below, document medical necessity, and confirm any local guidance with your MAC.

INFeD (J1750) Medicare Coverage & FDA Indications

Page reviewed Aug 23, 2026 · from FDA-approved labeling (Drugs@FDA) — no drug-specific Medicare LCD

Quick answer

Medicare benefit

Part B (physician-administered)

FDA-indicated diagnoses

3 ICD-10 codes

Governing policy

FDA indications (no LCD)

Contractor (MAC)

Per medical necessity

Source

FDA labeling

Page reviewed

Aug 23, 2026

HCPCS codes covered:
J1750

No drug-specific Medicare coverage article exists for INFeD. Coverage is decided per medical necessity by your MAC. The FDA-approved indications below are the labeled uses Medicare generally pays for; an off-label use may be covered if supported by an approved compendium. Find your MAC by state →

What Medicare pays for INFeD (2026 Q4)

2026 Q4 payment limit per billing unit for INFeD’s HCPCS code (how ASP + 6% works):

HCPCS	Description	Per unit	Allowed (ASP + 6%)
J1750	Inj iron dextran	50 mg	$19.005

CMS ASP Drug Pricing File, 2026 Q4. INFeD patient out-of-pocket estimate →

Worked billing example for INFeD

A concrete, paste-checkable example using J1750’s own billing-unit basis and vial sizes — not a hypothetical.

Scenario	100 mg per-session dose (one full vial, typical multi-session Ganzoni-based regimen)
Dose administered	100 mg
Billing unit basis	1 unit = 50 mg
Billing units (dose ÷ unit basis, rounded up)	2 units of J1750
Vial combination drawn (min-waste plan)	1 × 100 mg vial
Discarded (waste)	None
Wastage modifier (JW / JZ)	Bill all 2 units on a single line with JZ (attests zero drug discarded). JW vs JZ, with examples →
Medicare allowable (ASP + 6%, 2026 Q4)	2 units × $19.005/unit = $38.01

Allowable, not paid: sequestration and the covered diagnosis still apply.

Dose source: drugs/infed.html — FAQ: "A 100 mg dose (one full vial) reimburses at approximately $36.21 (2 units × $18.105).". Different dose or drug? Compute your own dose → or estimate the full cost & patient out-of-pocket →.

INFeD (HCPCS J1750) is paid under Part B only when the claim’s ICD-10 code is one the MAC accepts; otherwise expect a CO-50 denial. How Part B drug coverage is decided →

Covered ICD-10 diagnoses for INFeD

The 3 FDA-approved indications for J1750, grouped by condition — filter to find a code.

Iron Deficiency Anemia — 3 diagnoses (applies to J1750)

Blood, blood-forming organs & immune disorders (3)

ICD-10	Covered diagnosis
D50.0	Iron deficiency anemia secondary to blood loss (chronic)
D50.8	Other iron deficiency anemias
D50.9	Iron deficiency anemia, unspecified

What commercial payers require for INFeD

Medicare Part B is only half the answer — most INFeD claims are adjudicated by a commercial plan with its own medical policy. Below is what 11 commercial payers publish for INFeD, read from each payer's own policy document. 4 of 7 that state a position require prior authorization (4 do not say clearly, so confirm those on the call), and 2 run a site-of-care program that can push the infusion out of the hospital outpatient setting. 3 name a preferred product you must try or fail first.

Payer	Prior auth	Preferred product first	Site of care	Indications named	Policy date
Aetna policy ↗	Unclear — confirm on the call	J1750	—	1	2026-07-01
Anthem / Elevance policy ↗	Required	—	—	1	2025-09-10
Arkansas BCBS policy ↗	Required	—	—	1	—
BCBS South Carolina policy ↗	Required	—	—	2	—
Blue Shield of California policy ↗	Required	—	—	1	2025-05-21
Excellus BCBS policy ↗	Not required	—	—	1	2026-07-16
Florida Blue policy ↗	Not required	—	—	1	2026-06-01
Independence Blue Cross policy ↗	Not stated — confirm on the call	J1750	reimbursement limited to the most appropriate, cost-effective setting	1	2026-07-01
Premera Blue Cross policy ↗	Not stated — confirm on the call	—	Site-of-care program applies	—	2026-06-01
UnitedHealthcare policy ↗	Not stated — confirm on the call	—	—	—	2026-09-01
Wellmark BCBS policy ↗	Not required	J1750	—	1	2025-01-01

What INFeD payers put in writing

Quoted from the medical policies linked above — 20 distinct requirements across 11 payers. These are the sentences an appeal has to answer.

Clinical prerequisites — what must be true before they pay

Treatment of members 18 years of age and older with moderate to severe restless leg syndrome (RLS) when both of the following criteria are met— Aetna policy ↗
Individual has had a four (4) week trial of and inadequate response, or intolerance to oral iron supplementation— Anthem / Elevance policy ↗
The member must be 18 years of age or older.— BCBS South Carolina policy ↗
Serum ferritin less than 30 ng/mL OR transferrin saturation (TSAT) less than 20%, OR an absence of stainable iron in bone marrow.— BCBS South Carolina policy ↗
Measured ferritin level is less than 100 ng/mL, transferrin saturation (TSAT) less than 30%, or an absence of stainable iron in bone marrow— BCBS South Carolina policy ↗
All lab values submitted must be within 60 days of request.— BCBS South Carolina policy ↗

Prior authorization

Precertification of Feraheme, Ferrlecit, Injectafer, Monoferric, and Venofer are required of all Aetna participating providers and members in applicable plan designs.— Aetna policy ↗
When a drug is being reviewed for coverage under a member’s medical benefit plan or is otherwise subject to clinical review (including prior authorization)— Anthem / Elevance policy ↗
Iron dextran (INFeD, Dexferrum), iron sucrose (Venofer), and sodium ferric gluconate complex (Ferrlecit) do not require prior authorization.— Florida Blue policy ↗
The following condition(s) require Prior Authorization/Preservice.— Blue Shield of California policy ↗
Based upon our assessment, the Health Plan considers the following medications medically appropriate and covered without prior authorization.— Excellus BCBS policy ↗
The preferred products are considered medically necessary and do not require prior authorization.— Wellmark BCBS policy ↗

Quantity and frequency limits

Initial Duration of Approval: 3 months— BCBS South Carolina policy ↗
Dose is based lean body weight hemoglobin level. See Additional Information Section •A dose is covered intravenously or intramuscularly as often as once daily— Blue Shield of California policy ↗
Daily doses of Infed should not exceed 2 mL, which may necessitate infusions over multiple days to administer the required therapeutic dose.— Excellus BCBS policy ↗

Reauthorization / continuation

Coverage Period: Yearly, based on continued response to therapy— Blue Shield of California policy ↗

Site-of-care restrictions

The Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting— Independence Blue Cross policy ↗

Exclusions and contraindications

Aetna considers intravenous iron therapy contraindicated and experimental, investigational, or unproven for members with genetic hemochromatosis or hemochromatosis secondary to iron overload.— Aetna policy ↗
Feraheme and Infed have black box warnings for fatal and serious hypersensitivity reactions including anaphylaxis, and as such, the administration of which should only occur when personnel and therapies are immediately available for the treatment of anaphylaxis and other hypersensitivity reactions— Anthem / Elevance policy ↗
All other uses for intravenous iron are considered experimental/investigational and, therefore, not covered unless the indication is supported as an accepted off-label use— Independence Blue Cross policy ↗

Read from each payer's published medical policy between 2026-08-03 and 2026-08-13. Every requirement above is quoted from the policy it links to. Commercial policy changes without notice — confirm before you bill.

How to bill INFeD

Put a medically necessary, FDA-indicated diagnosis from the list above on the claim line with J1750. Matching codes, units and JZ/JW wastage →

Which policy governs INFeD

No drug-specific LCD or Article — see the note at the top of this page. Find your MAC → What an LCD, an Article and an NCD each govern →

If a claim for INFeD is denied

With no drug-specific Article, the usual cause is a diagnosis the MAC does not accept as medically necessary for J1750, or an off-label use with no compendium support. The five denial patterns and how to fix each →

Frequently asked questions

Is INFeD covered by Medicare?: Yes. INFeD (J1750) is covered under Medicare Part B as a physician-administered drug when billed for a medically necessary indication. There is no drug-specific Local Coverage Determination (LCD) for it, so coverage is determined per medical necessity by your MAC; the FDA-approved indications below are the starting point. None of the 8 Medicare Administrative Contractors lists J1750 as self-administered.
What diagnoses are covered for INFeD (J1750)?: Medicare publishes no drug-specific covered-diagnosis list for J1750. The 3 ICD-10 codes here are the FDA-approved indications; an off-label use needs approved-compendium support (DrugDex, NCCN) to be payable.
Which Medicare policy covers INFeD?: No drug-specific LCD or Billing & Coding Article exists for INFeD. It's covered under the general Medicare Part B drug benefit per medical necessity, as judged by your Medicare Administrative Contractor (MAC).
Why was my INFeD claim denied as not medically necessary?: The most common cause is a diagnosis the MAC doesn't consider medically necessary for J1750. Bill a covered/FDA-approved indication from the list below, document medical necessity, and confirm any local guidance with your MAC.

Related references

Covered is only half the answer.

You know the diagnosis is payable. Now quote the patient before the visit and catch underpayments: get INFeD's exact Medicare allowed amount, your payer's rate vs. ASP+6%, and the patient's out-of-pocket — in about 30 seconds, free.

Estimate INFeD cost & patient owe →

Source & verification

Source: FDA-approved indications (Drugs@FDA labeling) mapped to ICD-10-CM. No drug-specific Medicare LCD/Article exists for INFeD — Part B coverage is determined per medical necessity by your MAC.
Primary sources: DailyMed — INFeD prescribing information · CMS Part B Drug ASP Pricing File — the quarterly payment limit quoted above · CMS Medicare Coverage Database — searched for “INFeD”; no drug-specific NCD, LCD or Billing & Coding Article exists, which is why the FDA-indicated codes above are the working list
Page last reviewed by CareCost: Aug 23, 2026 (coverage data retrieved 2026-09-21; we re-verify against CMS quarterly).
Notes: ICD-10-CM is public domain; CPT® (AMA) is intentionally not listed. Reference, not billing advice — built from the CMS Coverage API per our methodology; corrections to editorial@carecostestimate.com.