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Ferrlecit (Sodium ferric gluconate complex)


Billing

Code: J2916

Description: Na ferric gluconate complex

Unit: 12.5 mg

Payment: $2.091

Pay quarter: Q1 2023


Medicare history

Dosage and Frequency

Iron Deficiency Anemia (IDA)

• 125mg IV
• 1.5mg/kg IV for pediatric patients

Calculate drug reimbursement


Total Reimbursement:

$22.16

(ASP: $20.91, Margin: $1.25)


Code:

J2916

# Units to bill:

10

Prior Authorization

Prior auth criteria for Ferrlecit may include but is not limited to:





Insurance prior auth guidelines:


Billable NDCs

00024-2792-10

Ferrlecit (SANOFI-AVENTIS)

625 MG


00024-2794-10

Ferrlecit (SANOFI-AVENTIS)

625 MG


00143-9298-10

SODIUM FERRIC GLUCONATE (HIKMA PHARMACEUTICALS USA INC.)

625 MG


00143-9570-10

SODIUM FERRIC GLUCONATE (HIKMA PHARMACEUTICALS USA INC.)

625 MG



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