Aranesp (J0881): Medicare covered diagnoses & ICD-10 codes

What Medicare pays for Aranesp (2026 Q3)

Once a claim carries a covered diagnosis, Medicare Part B reimburses the drug at the ASP + 6% payment limit. Current allowed amounts per billing unit:

Source: CMS ASP Drug Pricing File, 2026 Q3. Payment = ASP + 6% per unit; multiply by units billed (watch JZ/JW wastage). Your patient's share is typically 20% after the deductible. Estimate the full cost & patient out-of-pocket →

Worked billing example for Aranesp

A concrete, paste-checkable example using J0881’s own billing-unit basis and vial sizes — not a hypothetical.

This is Medicare’s allowable payment limit (ASP + 6%, 2026 Q3) — not a promise of what you will be paid. Actual paid amount depends on sequestration and whether the claim carries a covered diagnosis.

Dose source: drugs/aranesp.html — "Worked example — CIA fixed dose, 70 kg patient": 500 mcg q3w fixed dose during chemo (single 500 mcg PFS, no waste). Different dose or drug? Compute your own dose → or estimate the full cost & patient out-of-pocket →.

Aranesp is a physician-administered biologic billed under Medicare Part B (not the Part D pharmacy benefit). Under Part B, Medicare pays the practice for the drug (HCPCS J0881) plus its administration — but only when the claim's diagnosis (ICD-10) code supports medical necessity. Each MAC publishes the specific covered diagnoses in a Billing & Coding Article; a claim with a diagnosis outside that list is typically denied as not medically necessary (CO-50).

Covered ICD-10 diagnoses for Aranesp

The 1060 codes below are the diagnoses Wellpoint Federal accepts for J0881 under Article A60381, grouped exactly as CMS groups them and organized by condition category for scanning. Use the filter in each group to find a specific code or condition.

What commercial payers require for Aranesp

Medicare Part B is only half the answer — most Aranesp claims are adjudicated by a commercial plan with its own medical policy. Below is what 26 commercial payers publish for Aranesp, read from each payer's own policy document. 18 of 26 that state a position require prior authorization, and 1 run a site-of-care program that can push the infusion out of the hospital outpatient setting. 1 name a preferred product you must try or fail first.

What Aranesp payers put in writing

Quoted from the medical policies linked above — 24 distinct requirements across 26 payers. These are the sentences an appeal has to answer.

Clinical prerequisites — what must be true before they pay

• All members must be assessed for iron deficiency anemia and have adequate iron stores (defined as a serum transferrin saturation [TSAT] level greater than or equal to 20% within the prior 3 months) or are receiving iron therapy before starting Aranesp.— Aetna, BCBS Tennessee, CareFirst BCBS policy ↗
• Authorization of 12 months may be granted for treatment of anemia due to chronic kidney disease in members with pretreatment hemoglobin less than 10 grams per deciliter (g/dL).— BCBS Tennessee, CareFirst BCBS policy ↗
• Authorization of 6 months may be granted for treatment of anemia due to myelosuppressive chemotherapy in members with non-myeloid malignancy and pretreatment hemoglobin less than 10 g/dL.— BCBS Tennessee, CareFirst BCBS policy ↗
• Individual has a baseline hemoglobin (Hgb) level less than 10 g/dL— Anthem / Elevance policy ↗
• Chemotherapy is planned for a minimum of 2 months— Anthem / Elevance policy ↗
• If designated, individual has had a trial and inadequate response or intolerance to one preferred ESA— Anthem / Elevance policy ↗

Prior authorization

• Precertification of erythropoiesis stimulating agents (Aranesp, Epogen, Procrit, Retacrit, Mircera) is 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 ↗
• Effective August 1, 2021, for members of plans that utilize an oncology benefits management program, Prior Approval is required for this service when rendered for oncologic indications and is managed through the oncology benefits management program.— Arkansas BCBS policy ↗
• Prior authorization is required to ensure the safe, clinically appropriate, and cost-effective use of Aranesp while maintaining optimal therapeutic outcomes.— BCBS Federal Employee Program policy ↗
• All requests must meet the Prior Authorizations requirement.— BCBS Massachusetts policy ↗
• Coverage is provided when the criteria below are met and there has been a trial and failure of preferred therapy (if applicable).— BCBS South Carolina policy ↗

Quantity and frequency limits

• CKD (Non-ESRD Patients [i.e., Non-Dialysis]): 600 billable units every 28 days— BCBS Kansas, BCBS Minnesota, Capital BlueCross policy ↗
• Chemotherapy-induced: 600 billable units every 21 days— BCBS Kansas, BCBS Minnesota, Capital BlueCross policy ↗
• Authorization of 12 months may be granted for treatment of anemia due to chronic kidney disease in members with pretreatment hemoglobin less than 10 grams per deciliter (g/dL).— BCBS Tennessee, CareFirst BCBS policy ↗
• 4 syringes (1.6 mL) per 28 days— Anthem / Elevance policy ↗
• Approve x 6 months if Hb ≤ 11.0 g/dL— BCBS Massachusetts policy ↗
• Medicaid/HIM/ICHRA – 6 months Commercial – 6 months or to member’s renewal period, whichever is longer— Centene / Ambetter policy ↗

Dosing rules

• CKD on dialysis: starting dose 0.45 mcg/kg IV or SC weekly, or 0.75— Centene / Ambetter policy ↗
• Starting dose: 2.25 mcg/kg SC weekly, or 500 mcg SC every 3 weeks until completion of a chemotherapy course— Centene / Ambetter policy ↗
• Dose and frequency should be in accordance with the FDA label or recognized compendia (for off-label uses).— Excellus BCBS policy ↗
• Current hemoglobin > 10 g/dL to ≤ 12 g/dL and prescriber will interrupt or decrease dosing to the lowest dose sufficient to reduce the need for red— HMSA (BCBS Hawaii) policy ↗
• On Dialysis: Adult : 0.45 mcg/kg IV or SQ wkly or 0.75 mcg/kg IV every 2 wks Pediatric: 0.45 mcg/kg IV or SQ wkly Not on Dialysis: Adult : 0.45 mcg/kg IV or SQ once at 4-wk intervals Pediatric : 0.75 mcg/kg IV or SQ every 2 wks— Independence Blue Cross policy ↗
• 2.25 mcg/kg SQ wkly 500 mcg SQ every 3 wks MAINTENANCE DOSE If Hb remains <10 g/dL— 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 Aranesp

Put the patient's covered ICD-10 diagnosis on the claim line with J0881. Matching codes, units and JZ/JW wastage →

Which policy governs Aranesp

The covered code lists live in Article A60381 — CMS moved code lists out of LCDs and into Articles, which is why the diagnoses live in the Article. What an LCD, an Article and an NCD each govern →

If a claim for Aranesp is denied

The usual cause is a diagnosis outside Article A60381's covered list, or a product code and unit count that do not match what was given. The five denial patterns and how to fix each →