When it comes to medical billing especially for drug therapies and intravenous (IV) treatments—accurate coding is essential for compliance and proper reimbursement. HCPCS code Q0138 is commonly searched by providers and billers looking to understand drug billing for iron deficiency anemia. This guide explains what Q0138 is, how it’s used, billing rules, and common questions surrounding this code.
What Is HCPCS Code Q0138?
HCPCS Code Q0138 is a Level II HCPCS “Q” code used to report:
Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-ESRD use).
This code represents the drug ferumoxytol itself, not the administration of the drug. It is specifically used for patients who do not have end-stage renal disease (non-ESRD).
Ferumoxytol is an intravenous iron replacement therapy often prescribed when oral iron supplements are ineffective or not tolerated.
Key Details of Q0138
- Code Type: HCPCS Level II (temporary Q code)
- Drug Name: Ferumoxytol
- Dosage Unit: 1 mg per unit
- Condition Treated: Iron deficiency anemia
- Patient Population: Non-ESRD patients
When Is Q0138 Used?
Q0138 is used when:
- A patient is diagnosed with iron deficiency anemia
- Ferumoxytol is administered via IV infusion or injection
- The patient is not on dialysis and does not have ESRD
- The provider needs to bill for the medication supplied
If the patient has ESRD and is receiving dialysis, a different HCPCS code is typically required.
How to Bill HCPCS Code Q0138
Q0138 is billed based on the total milligrams administered.
- 1 unit = 1 mg of ferumoxytol
- Example: If 510 mg is administered, bill 510 units of Q0138
This code is usually billed alongside a CPT administration code, such as an IV infusion code, to reflect both:
- The drug provided (Q0138)
- The service of administering the drug (CPT code)
Common CPT Codes Billed With Q0138
While Q0138 reports the medication, it is commonly paired with:
- IV infusion administration codes
- Injection or therapeutic infusion CPT codes
The exact CPT code depends on how the medication is administered and the duration of the infusion.
Documentation Requirements
Accurate documentation is critical when billing Q0138. Records should include:
- Diagnosis supporting medical necessity
- Drug name and dosage administered
- Route of administration
- Date of service
- Provider signature
- Number of units billed
Incomplete or unclear documentation is a frequent cause of claim denials.
Common Billing Errors to Avoid
- Billing Q0138 for ESRD or dialysis patients
- Incorrect unit calculation
- Missing or mismatched diagnosis codes
- Billing the drug without an administration code
- Lack of medical necessity documentation
Why Q0138 Matters in Medical Billing
Q0138 ensures providers are properly reimbursed for the cost of ferumoxytol, which can be significant. Correct use of this code supports clean claims, reduces denials, and maintains compliance with payer guidelines.
Because drug codes are frequently audited, accuracy with Q0138 is especially important.
Frequently Asked Questions About Q0138
Is Q0138 a CPT code?
No. Q0138 is an HCPCS Level II code used for billing drugs and supplies.
Does Q0138 include administration?
No. It only covers the drug. Administration must be billed separately.
Is prior authorization required?
Some payers may require prior authorization, depending on policy.
Can Q0138 be billed multiple times?
Yes, units are billed based on the total dosage administered.
Conclusion
HCPCS code Q0138 is used to report ferumoxytol injections for treating iron deficiency anemia in non-ESRD patients. Understanding its dosage units, billing rules, and documentation requirements helps providers submit accurate claims and avoid reimbursement issues.
Proper use of Q0138 is essential for compliant, efficient drug billing and ensures providers are fairly compensated for the medication supplied.