J7165 HCPCS code: Injection, prothrombin complex concentrate, human-lans, per i.u. of factor ix activity
J7165 is the HCPCS Level II code for injection, prothrombin complex concentrate, human-lans, per i.u. of factor ix activity. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 5000 per day on outpatient hospital claims.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2024-04-01 |
| Last action effective | 2024-04-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 5000 | Prescribing Information |
| practitioner claims | 5000 | Prescribing Information |
What changed for J7165
- 2024-04-01: J7165 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J7165?
J7165 is the HCPCS Level II code for injection, prothrombin complex concentrate, human-lans, per i.u. of factor ix activity. Short descriptor: "Inj, human-lans, per i.u".
Does Medicare cover J7165?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J7165 can be billed per day?
5000 on outpatient hospital claims; 5000 on practitioner claims (NCCI medically unlikely edits).
Related J71 codes
- J7100 — Infusion, dextran 40, 500 ml
- J7110 — Infusion, dextran 75, 500 ml
- J7120 — Ringers lactate infusion, up to 1000 cc
- J7121 — 5% dextrose in lactated ringers infusion, up to 1000 cc
- J7131 — Hypertonic saline solution, 1 ml
- J7168 — Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity
- J7169 — Injection, coagulation factor xa (recombinant), inactivated-zhzo (andexxa), 10 mg
- J7170 — Injection, emicizumab-kxwh, 0.5 mg
- J7171 — Injection, adamts13, recombinant-krhn, 10 iu
- J7172 — Injection, marstacimab-hncq, 0.5 mg
- J7173 — Injection, concizumab-mtci, 0.5 mg
- J7174 — Injection, fitusiran, 0.04 mg
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Next steps
- Run a reimbursement report for a device billed under J7165
- Watch J7165 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J7165
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.