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Intravenous Iron Therapy (CPB 0575, reviewed 2026-07-01)
Effective date
Not stated in the notice
Identified
Aug 16, 2026
Summary
Feraheme, Ferrlecit, Injectafer, Monoferric and Venofer are medically necessary only for commercial members who have a contraindication, intolerance or ineffective response to the lower cost alternatives generic ferumoxytol, generic iron sucrose, generic sodium ferric gluconate and INFeD (iron dextran) for the labeled indication. Precertification is required for Feraheme, Ferrlecit, generic sodium ferric gluconate, Injectafer, Monoferric, Venofer and generic iron sucrose in applicable plan designs. Intravenous iron is considered experimental, investigational or unproven for other indications, including acute mountain sickness and anemia of inflammation, and it is contraindicated for genetic hemochromatosis or hemochromatosis secondary to iron overload.
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What to do
Action · 8 steps
01Precertification: Precertification is required of Aetna participating providers for Feraheme, Ferrlecit, generic sodium ferric gluconate, Injectafer, Monoferric, Venofer and generic iron sucrose in applicable plan designs.
02Call (866) 752-7021 or fax (888) 267-3277 for precertification, and use the Statement of Medical Necessity forms listed under Specialty Pharmacy Precertification.
03Brand products: For Feraheme, Ferrlecit, Injectafer, Monoferric and Venofer, document a contraindication, intolerance or ineffective response to the equivalent generic alternative for the labeled indication (generic ferumoxytol, generic iron sucrose, generic sodium ferric gluconate or INFeD).
04If the less cost intravenous iron product does not have the labeled indication, the claim needs another intravenous iron product that has the required labeled indication.
05Iron deficiency anemia: Document iron deficiency anemia with an unsatisfactory response, intolerance or contraindication to oral iron administration, and confirm it with the policy thresholds, such as serum ferritin less than 30 ng/mL or transferrin saturation less than 20 percent without chronic kidney disease.
06Codes: Injectafer is billed under HCPCS J1439, Monoferric under J1437, Feraheme or generic ferumoxytol under Q0138 (non-ESRD use) or Q0139 (ESRD on dialysis), INFeD under J1750, Venofer under J1756 and Ferrlecit or generic sodium ferric gluconate under J2916, when selection criteria are met.
07Experimental indications: Aetna considers intravenous iron experimental, investigational or unproven for indications not listed as medically necessary in the policy, including acute mountain sickness and anemia of inflammation.
08Continuation of therapy: Continuation of therapy is medically necessary for members who meet criteria for an indication listed in the policy.
Codes mentioned
J1439J1437Q0138Q0139J1750J1756J2916J0885J0887J0888Q4081D50.0D50.9D62D63.0D63.1D63.8D64.81E83.10E83.110E83.111G25.81K50.00K51.00K91.1N18.6N18.9N92.2N92.4N95.0O99.011O99.019S72.001AT70.29XAZ52.010Z88.8Z90.3Z98.84Z99.2
Original notice
Intravenous Iron Therapy (CPB 0575, reviewed 2026-07-01)
aetna.com · Always check the source before changing claims.
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Related policy hubs
Aetna policiesHematologyNephrologyOncologyCardiologyGastroenterologyOB-GYNBariatric SurgeryNeurologyCode J1439Code J1437Code Q0138Code Q0139Code J1750Code J1756Code J2916Code J0885Code J0887Code J0888Code Q4081Code D50.0Code D50.9Code D62Code D63.0Code D63.1Code D63.8Code D64.81Code E83.10Code E83.110Code E83.111Code G25.81Code K50.00Code K51.00Code K91.1Code N18.6Code N18.9Code N92.2Code N92.4Code N95.0Code O99.011Code O99.019Code S72.001ACode T70.29XACode Z52.010Code Z88.8Code Z90.3Code Z98.84Code Z99.2