J7198 HCPCS code: Anti-inhibitor, per i.u.
J7198 is the HCPCS Level II code for anti-inhibitor, per i.u.. In 2022 Medicare paid an average of $2.09 per service for J7198 across 5,242,009 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 30000 per day on outpatient hospital claims. In 2022, about 19 clinicians billed Medicare for J7198 for 14 beneficiaries.
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 | 2000-01-01 |
| Last action effective | 2000-01-01 |
Who bills J7198 (2022)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 19 |
| Medicare beneficiaries | 14 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J7198, 2022–2022
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 5,242,009 | 14 | $2.62 | $2.09 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 30000 | Prescribing Information |
| practitioner claims | 6000 | 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 J7198
- 2000-01-01: J7198 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 J7198?
J7198 is the HCPCS Level II code for anti-inhibitor, per i.u.. Short descriptor: "Anti-inhibitor".
How much does Medicare pay for J7198?
In 2022, the average Medicare payment was $2.09 per service (average allowed $2.62).
Does Medicare cover J7198?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J7198?
Medicare policy articles that cite J7198 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 J7198 can be billed per day?
30000 on outpatient hospital claims; 6000 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
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J7198
- Watch J7198 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J7198
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.