J7168 HCPCS code: Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity
J7168 is the HCPCS Level II code for prothrombin complex concentrate (human), kcentra, 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 | 2021-07-01 |
| Last action effective | 2021-07-01 |
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 J7168
- 2021-07-01: J7168 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 J7168?
J7168 is the HCPCS Level II code for prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity. Short descriptor: "Prothrombin complex kcentra".
Does Medicare cover J7168?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J7168 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
- J7165 — Injection, prothrombin complex concentrate, human-lans, 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 J7168
- Watch J7168 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J7168
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.