J7192 HCPCS code: Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified
J7192 is the HCPCS Level II code for factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified. In 2024 Medicare paid an average of $1.41 per service for J7192 across 30,387,974 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 22000 per day on outpatient hospital claims. Medicare volume fell 26% from 2022 to 2024 (41,202,113 to 30,387,974 services). In 2024, about 135 clinicians billed Medicare for J7192 for 340 beneficiaries; Pennsylvania, California, Washington accounted for 81% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 1994-01-01 |
| Last action effective | 2010-01-01 |
Who bills J7192 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 135 |
| Medicare beneficiaries | 340 |
| States with claims | 10 |
| Share of services in top 3 states (Pennsylvania, California, Washington) | 81% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J7192, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 41,202,113 | 461 | $1.97 | $1.57 |
| 2023 | 35,099,681 | 368 | $1.78 | $1.42 |
| 2024 | 30,387,974 | 340 | $1.77 | $1.41 |
States with the most J7192 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Pennsylvania | 10,446,914 | $1.14 |
| California | 8,302,748 | $1.19 |
| Washington | 2,145,242 | $1.02 |
| Illinois | 1,228,858 | $1.23 |
| Florida | 1,070,163 | $1.20 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 22000 | Clinical: Data |
| practitioner claims | 22000 | Clinical: Data |
Medicare policy articles for this code
- A56065: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 (Palmetto GBA (MAC - Part B))
- A56065: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 (Palmetto GBA (MAC - Part B))
Covered diagnoses (15 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| D66 | Hereditary factor VIII deficiency | 1 |
| D67 | Hereditary factor IX deficiency | 1 |
| D68.01 | Von Willebrand disease, type 1 | 1 |
| D68.020 | Von Willebrand disease, type 2A | 1 |
| D68.021 | Von Willebrand disease, type 2B | 1 |
| D68.022 | Von Willebrand disease, type 2M | 1 |
| D68.023 | Von Willebrand disease, type 2N | 1 |
| D68.03 | Von Willebrand disease, type 3 | 1 |
| D68.04 | Acquired von Willebrand disease | 1 |
| D68.09 | Other von Willebrand disease | 1 |
Showing 10 of 15. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J7192
- 1994-01-01: J7192 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 J7192?
J7192 is the HCPCS Level II code for factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified. Short descriptor: "Factor viii recombinant nos".
How much does Medicare pay for J7192?
In 2024, the average Medicare payment was $1.41 per service (average allowed $1.77).
Does Medicare cover J7192?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J7192?
Medicare policy articles that cite J7192 list 15 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include D66 (Hereditary factor VIII deficiency), D67 (Hereditary factor IX deficiency), D68.01 (Von Willebrand disease, type 1). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J7192 can be billed per day?
22000 on outpatient hospital claims; 22000 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
- 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
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Next steps
- Run a reimbursement report for a device billed under J7192
- Watch J7192 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J7192
Sources: CMS HCPCS Level II release October 2025; 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.