Quick answer
J1439
What Medicare pays for Injectafer (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:
| HCPCS | Description | Per unit | Allowed (ASP + 6%) |
|---|---|---|---|
| J1439 | Inj ferric carboxymaltos 1mg | 1 mg | $1.132 |
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 Injectafer
A concrete, paste-checkable example using J1439’s own billing-unit basis and vial sizes — not a hypothetical.
| Scenario | 750 mg standard adult dose (one vial, patients ≥50 kg) |
| Dose administered | 750 mg |
| Billing unit basis | 1 unit = 1 mg |
| Billing units (dose ÷ unit basis, rounded up) | 750 units of J1439 |
| Vial combination drawn (min-waste plan) | 1 × 750 mg vial |
| Discarded (waste) | None |
| Wastage modifier (JW / JZ) | Bill all 750 units on a single line with JZ (attests zero drug discarded). What JZ/JW mean → |
| Medicare allowable (ASP + 6%, 2026 Q3) | 750 units × $1.132/unit = $849.00 |
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/injectafer.html — "Standard dose 750 units — 750 mg × 2 doses, ≥7 days apart" (adult ≥50 kg regimen, not the <50 kg / 15 mg/kg path). Different dose or drug? Compute your own dose → or estimate the full cost & patient out-of-pocket →.
Injectafer 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 J1439) 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 Injectafer
The 8 FDA-approved indications for J1439, grouped by condition — filter to find a code.
Iron Deficiency Anemia — 4 diagnoses (applies to J1439)
Blood, blood-forming organs & immune disorders (4)
| ICD-10 | Covered diagnosis |
|---|---|
| D50.0 | Iron deficiency anemia secondary to blood loss (chronic) |
| D50.1 | Sideropenic dysphagia |
| D50.8 | Other iron deficiency anemias |
| D50.9 | Iron deficiency anemia, unspecified |
Anemia of CKD — 1 diagnoses (applies to J1439)
Blood, blood-forming organs & immune disorders (1)
| ICD-10 | Covered diagnosis |
|---|---|
| D63.1 | Anemia in chronic kidney disease |
Pregnancy-Related Anemia — 1 diagnoses (applies to J1439)
Pregnancy, childbirth & the puerperium (1)
| ICD-10 | Covered diagnosis |
|---|---|
| O99.019 | Anemia complicating pregnancy, unspecified trimester |
GI-Related Anemia — 1 diagnoses (applies to J1439)
Diseases of the digestive system (1)
| ICD-10 | Covered diagnosis |
|---|---|
| K50.90 | Crohn's disease (GI blood loss) |
Menstrual-Related Anemia — 1 diagnoses (applies to J1439)
Diseases of the genitourinary system (1)
| ICD-10 | Covered diagnosis |
|---|---|
| N92.0 | Excessive and frequent menstruation with regular cycle |
What commercial payers require for Injectafer
Medicare Part B is only half the answer — most Injectafer claims are adjudicated by a commercial plan with its own medical policy. Below is what 16 commercial payers publish for Injectafer, read from each payer's own policy document. 14 of 16 that state a position require prior authorization, and 2 run a site-of-care program that can push the infusion out of the hospital outpatient setting.
| Payer | Prior auth | Preferred product first | Site of care | Indications named | Policy date |
|---|---|---|---|---|---|
| Aetna policy ↗ | Required | — | — | 3 | 2026-07-01 |
| Anthem / Elevance policy ↗ | Required | — | — | 3 | 2025-08-15 |
| Arkansas BCBS policy ↗ | Not required | — | — | 2 | — |
| BCBS Kansas policy ↗ | Required | — | — | 3 | 2026-05-05 |
| BCBS Minnesota policy ↗ | Required | — | — | 3 | 2025-05-05 |
| BCBS South Carolina policy ↗ | Required | — | — | 2 | — |
| Blue Shield of California policy ↗ | Required | — | — | 3 | 2025-05-21 |
| Capital BlueCross policy ↗ | Required | — | — | 3 | 2025-05-05 |
| Centene / Ambetter policy ↗ | Required | — | — | 3 | 2026-01-01 |
| Cigna policy ↗ | Required | — | — | 3 | 2026-04-01 |
| Excellus BCBS policy ↗ | Required | — | site of care may impact approval timeframe and is subject to review | 3 | 2026-06-01 |
| Florida Blue policy ↗ | Required | — | — | 2 | 2026-06-01 |
| Independence Blue Cross policy ↗ | Not required | — | Class-wide reservation of reimbursement to the most appropriate, cost-effective site of service, applicable to all IV iron products including ferric carboxymaltose | 3 | 2026-07-01 |
| Premera Blue Cross policy ↗ | Required | — | — | 3 | 2026-06-01 |
| UnitedHealthcare policy ↗ | Required | — | — | 3 | 2026-02-01 |
| Wellmark BCBS policy ↗ | Required | — | — | — | 2025-01-01 |
What Injectafer payers put in writing
Quoted from the medical policies linked above — 26 distinct requirements across 16 payers. These are the sentences an appeal has to answer.
Clinical prerequisites — what must be true before they pay
Patient had an intolerance or inadequate response to a minimum of 14 days of oral iron
— BCBS Minnesota, Capital BlueCross policy ↗Patient is at least 18 years of age, unless otherwise specified
— BCBS Minnesota, Capital BlueCross policy ↗Patient is at least 1 year of age
— BCBS Minnesota, Capital BlueCross policy ↗Other supplemental iron is to be discontinued prior to administration of ferric carboxymaltose
— BCBS Minnesota, Capital BlueCross policy ↗Aetna considers continuation of ferric carboxymaltose (Injectafer) intravenous iron therapy medically necessary for members who meet criteria for an indication listed in Section I
— Aetna policy ↗Individual has had a four (4) week trial of and inadequate response, or intolerance to oral iron supplementation
— Anthem / Elevance 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 ↗Initiation and continuation of injectable iron therapy meets the definition of medical necessity when ALL of the follow
— Florida Blue policy ↗The following condition(s) require Prior Authorization/Preservice.
— Blue Shield of California policy ↗Provider must submit documentation (including such as office chart notes, lab results or other clinical information) supporting that member has met all approval criteria.
— Centene / Ambetter policy ↗Prior Authorization is required for benefit coverage of Injectafer.
— Cigna policy ↗
Quantity and frequency limits
1500 billable units per 35 days
— BCBS Kansas, BCBS Minnesota, Capital BlueCross policy ↗Injectafer 15 mg/kg body weight up to a maximum of 1,000 mg
— Aetna policy ↗Initial Duration of Approval: 3 months
— BCBS South Carolina policy ↗Injectafer 15 mg/kg body weight up to a maximum of 1,000 mg IV may be administered as a single-dose per course
— Excellus BCBS policy ↗
Dosing rules
Dose does not exceed 750 mg every 7 days (maximum 2 doses per treatment course)
— Florida Blue policy ↗Administer two doses of 750 mg intravenously separated by at least 7 days for a total cumulative dose not to exceed 1500 mg of iron per course
— BCBS Minnesota policy ↗Administer one dose of 15 mg/kg body weight intravenously up to a maximum of 1,000 mg of iron per course
— BCBS Minnesota policy ↗Administer two doses of 15 mg/kg body weight intravenously separated by at least 7 days for a total cumulative dose not to exceed 1500 mg of iron per course.
— BCBS Minnesota policy ↗Administer 500 mg intravenously at 12, 24 and 36 weeks if serum ferritin <100 ng/mL or serum ferritin 100-300 ng/mL with transferrin saturation <20%.
— BCBS Minnesota policy ↗1000 mg given intravenously per dose
— Blue Shield of California policy ↗
Reauthorization / continuation
Renewal: Prior authorization validity may be renewed for 35 days when initial criteria are met, unless otherwise specified.
— BCBS Kansas policy ↗Prior authorization validity may be renewed every 12 weeks (for 1 dose) up to a total of 3 maintenance doses.
— BCBS Kansas policy ↗Coverage will be provided for 12 weeks (for up to 2 doses) initially and may be renewed every 12 weeks (for 1 dose) up to a total of 3 maintenance doses
— Capital BlueCross policy ↗Continuation authorization will be for no longer than 12 months
— UnitedHealthcare 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 Injectafer
Put a medically necessary, FDA-indicated diagnosis from the list above on the claim line with J1439. Matching codes, units and JZ/JW wastage →
Which policy governs Injectafer
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 Injectafer is denied
With no drug-specific Article, the usual cause is a diagnosis the MAC does not accept as medically necessary for J1439, or an off-label use with no compendium support. The five denial patterns and how to fix each →
Frequently asked questions
- Is Injectafer covered by Medicare?
- Yes. Injectafer (J1439) 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.
- What diagnoses are covered for Injectafer (J1439)?
- Medicare publishes no drug-specific covered-diagnosis list for J1439. The 8 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 Injectafer?
- No drug-specific LCD or Billing & Coding Article exists for Injectafer. 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 Injectafer claim denied as not medically necessary?
- The most common cause is a diagnosis the MAC doesn't consider medically necessary for J1439. 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 Injectafer'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 Injectafer 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 Injectafer — Part B coverage is determined per medical necessity by your MAC.
- Primary sources
- DailyMed — Injectafer prescribing information · CMS Part B Drug ASP Pricing File — the quarterly payment limit quoted above · CMS Medicare Coverage Database — searched for “Injectafer”; 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 2026-08-26; we re-verify against CMS quarterly).
- Code licensing
- ICD-10-CM codes are public domain (CMS/CDC). CPT® codes are AMA-copyrighted and are intentionally not listed here — see the administration-code reference for those.
- Not advice
- This is general billing reference, not legal or billing advice. Always verify against the LCD/Article that applies to your MAC and patient.
- How we build this
- Compiled programmatically from the CMS Coverage API under a founder-led methodology maintained by Erin Rose (Founder), and reviewed against the source article with a practitioner-correction loop. See our methodology and editorial policy.
- Spotted an error?
- Email editorial@carecostestimate.com.