What Is the Venofer J Code in 2025?
The Venofer J Code for 2025 remains J1756, which corresponds to “Injection, iron sucrose, 1 mg” :cite[3]:cite[6]. This HCPCS code is critical for billing intravenous iron replacement therapy for patients with iron deficiency anemia (IDA), particularly those with chronic kidney disease (CKD). Venofer (iron sucrose) is administered intravenously, and J1756 is billed per milligram of the drug :cite[1]:cite[4].
For example, a 100 mg dose requires 100 units of J1756. Always verify the National Drug Code (NDC) on the vial, as multiple manufacturers produce Venofer :cite[4]. Need help with CMS 1500 claim form guidelines? Check our step-by-step guide.
Top 5 Questions About Venofer J Code in 2025
1. How Do I Correctly Code Venofer Infusions?
Billing Venofer requires two components:
- J1756: 1 unit = 1 mg of iron sucrose.
- CPT 96374: Therapeutic infusion (15+ minutes) or 96375 for sequential infusions :cite[2]:cite[4].
Example: A 200 mg infusion over 15 minutes would be billed as J1756 x 200 units + 96374. Avoid bundling with erythropoietin (e.g., Aranesp) on the same claim, as payers may deny it :cite[2]. For more on nephrology billing, explore our specialty-specific guide.
2. Are There 2025 Updates to J1756?
No changes were made to J1756 in the January 2025 HCPCS update :cite[5]. However, Medicare’s Average Sales Price (ASP) for Venofer dropped slightly to $0.237 per mg, with a 20% co-insurance rate :cite[4]. Always confirm payer-specific policies, as commercial plans may have prior authorization requirements. For Medicare reimbursement rules, review our latest analysis.
3. How to Avoid Denials for Venofer Claims?
Common denial reasons include:
- Missing NDC numbers (e.g., 00517-2310-05 for American Regent) :cite[4].
- Incorrect dosing units (report total mg, not vials).
- Lack of medical necessity documentation (e.g., CKD diagnosis + lab results).
Medicaid requires the JW modifier for discarded drug amounts, while Medicare Advantage plans may require the TB modifier for 340B-purchased drugs :cite[5].
4. What’s the Reimbursement Rate for J1756?
As of May 2025, Medicare’s payment limit is $0.237 per mg :cite[4]. Commercial payers like UnitedHealthcare and Aetna typically reimburse between $0.30–$0.50 per mg. Always cross-check the ASP and AWP quarterly, as prices fluctuate. For example, Venofer’s Wholesale Acquisition Cost (WAC) remained stable at $1.20 per mg in early 2025 :cite[4].
5. Can J1756 Be Used for Pediatric Patients?
Yes, but dosing differs. Pediatric CKD patients (≥2 years) receive 0.5 mg/kg, up to 100 mg per dose, every 2–4 weeks :cite[1]. Use modifier FP (FDA-approved pediatric indication) and link to ICD-10 code N18.x (CKD) + D50.9 (iron deficiency anemia).
Key Takeaways for 2025
- J1756 remains active with no coding changes :cite[6].
- Pair with 96374/96375 for infusions, but avoid same-day EPO claims.
- Monitor ASP updates and payer-specific modifiers.
For further reading, visit the CMS website or the AAPC’s coding forum.