Ferrlecit (Sodium ferric gluconate complex)
Billing
Code: J2916
Description: Na ferric gluconate complex
Unit: 12.5 mg
Payment: $2.091
Pay quarter: Q1 2023
Dosage and Frequency
Iron Deficiency Anemia (IDA)
• 125mg IV
• 1.5mg/kg IV for pediatric patients
• 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:
10Prior 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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