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Monoferric (ferric derisomaltose)


Billing

Code: J1437

Description: Inj. fe derisomaltose 10 mg

Unit: 10 mg

Payment: $22.713

Pay quarter: Q1 2023


Medicare history

Dosage and Frequency

Iron Deficiency Anemia (IDA)

• 1000mg IV if patient weighs 50kg or more
• 20mg/kg IV if patient weighs less than 50kg

Calculate drug reimbursement


Total Reimbursement:

$2,407.58

(ASP: $2,271.30, Margin: $136.28)


Code:

J1437

# Units to bill:

100

Prior Authorization

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





Insurance prior auth guidelines:


Billable NDCs

73594-9310-01

Monoferric (PHARMACOSMOS THERAPEUTICS)

1000 MG



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