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Independence Blue CrossMedicare Advantage · Coverage · Medical Policy · Hematology, OB-GYN, Oncology +4 moreMedium impact

MA08.150a, Intravenous (IV) Iron Preparations

Act
by Mar 23, 2026
Effective date
Mar 23, 2026
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated MA08.150a to MA08.150b, adding new coverage criteria for pediatric IV iron use and expanding ICD-10 diagnosis codes to include pregnancy-related anemias (O99.011-O99.019, O99.02, O99.03) and chemotherapy-induced anemia (D64.81). The policy maintains preferred vs. nonpreferred product designations with specific coverage rules based on prior treatment history and contraindication documentation.

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What to do

by Mar 23, 2026 · 4 steps
01Billing team must update coding systems to recognize newly added ICD-10 codes (D64.81, O99.011-O99.013, O99.019, O99.02, O99.03) for IV iron coverage eligibility.
02Providers must document contraindication or inadequate response to TWO OR MORE preferred IV iron products (ferumoxytol, ferric derisomaltose, sodium ferric gluconate) before authorizing nonpreferred products (ferric carboxymaltose, iron dextran, iron sucrose) UNLESS patient has prior history of nonpreferred product use for the specified indication.
03Prior authorization processes must reflect that nonpreferred product samples do not satisfy coverage exceptions.
04Update clinical documentation templates to capture pediatric-specific criteria when applicable, ensuring all claims under new pregnancy and chemotherapy-related anemia diagnoses include medical necessity justification.

Codes mentioned

A9574J1437J1439J1750J1756J2916Q0138Q0139D50.0D50.8D50.9D63.0D63.1D64.81E61.1O99.011O99.012O99.013O99.019O99.02O99.03

Original notice

MA08.150a, Intravenous (IV) Iron Preparations
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

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Related policy hubs

Independence Blue Cross policiesHematologyOB-GYNOncologyNephrologyCardiologyInternal MedicinePediatricsCode A9574Code J1437Code J1439Code J1750Code J1756Code J2916Code Q0138Code Q0139Code D50.0Code D50.8Code D50.9Code D63.0Code D63.1Code D64.81Code E61.1Code O99.011Code O99.012Code O99.013Code O99.019Code O99.02Code O99.03

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