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HCPCS J1437 · Level II · Part B drug

HCPCS J1437: Injection, ferric derisomaltose, 10 mg

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for J1437

Billing unit
10 MG
Inj. fe derisomaltose 10 mg
ASP payment limit
$21.877
October 2026; +3.8% vs July 2026
Practitioner MUE
100
MAI 3
OPPS status
SI K
APC 9388
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1437 is the Level II code for Injection, ferric derisomaltose, 10 mg, billed per 10 MG. The Medicare Part B ASP payment limit for October 2026 is $21.877 per billing unit, up 3.8% from July 2026. The practitioner MUE allows up to 100 units per date of service (MAI 3). Under OPPS it carries status indicator K in APC 9388. The 10 mg billing unit means doses are reported in multiples of ten milligrams, with any remainder rounded per contractor policy; mismatched units against the NDC quantity trigger MUE and NDC-unit edits. The ASP crosswalk maps 1 NDC to it, sold as Monoferric by Pharmacosmos Therapeutics Inc.. No current Billing and Coding Article lists J1437, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J1437 at $21.877 per 10 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $21.077 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1437
QuarterPayment limitPerCoinsurance
October 2026$21.87710 MG20%
July 2026$21.07710 MG—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 1 NDC from 1 labeler to J1437. Report the NDC in the claim's drug segment and bill the number of J1437 units that equals the quantity administered divided by 10 MG; the last column gives units per full package.

NDCs that crosswalk to J1437
NDCDrug nameLabelerPackage sizeBilling units / package
73594-9310-01MonoferricPharmacosmos Therapeutics Inc.10 × 1100

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for J1437. For practitioners the limit is 100 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for J1437 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services1003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital1003 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1437 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

J1437 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists J1437 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J1437 carries status indicator K and is assigned to APC 9388, with a published national unadjusted payment of $21.08. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J1437 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks J1437 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

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Frequently asked questions — HCPCS J1437

What does HCPCS code J1437 describe?

J1437 is defined by CMS as "Injection, ferric derisomaltose, 10 mg". Each billing unit represents 10 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1437 in October 2026?

The ASP-based payment limit is $21.877 per 10 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $21.077.

How many units of J1437 can be billed per day?

The practitioner Medically Unlikely Edit is 100 units per date of service with adjudication indicator 3 (3 Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Prescribing Information" as the rationale.

Which NDCs map to J1437?

The October 2026 ASP crosswalk lists 1 NDC from 1 labeler: Monoferric (Pharmacosmos Therapeutics Inc.). For example NDC 73594-9310-01 is a 10 package equal to 100 billing units. The crosswalk's billing-units-per-package figure converts each package into J1437 units.

Does J1437 have NCCI bundling edits?

No active practitioner PTP pairs list J1437 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.