Monoferric (ferric derisomaltose)
Billing
Code: J1437
Description: Inj. fe derisomaltose 10 mg
Unit: 10 mg
Payment: $22.713
Pay quarter: Q1 2023
Dosage and Frequency
Iron Deficiency Anemia (IDA)
• 1000mg IV if patient weighs 50kg or more
• 20mg/kg IV if patient weighs less than 50kg
• 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:
100Prior 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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