J7199 HCPCS code: Hemophilia clotting factor, not otherwise classified
J7199 is the HCPCS Level II code for hemophilia clotting factor, not otherwise classified. In 2023 Medicare paid an average of $5.82 per service for J7199 across 763,657 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. In 2023, about 20 clinicians billed Medicare for J7199 for 26 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 J7199 (2023)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 20 |
| Medicare beneficiaries | 26 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J7199, 2023–2023
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 763,657 | 26 | $7.30 | $5.82 |
What changed for J7199
- 2000-01-01: J7199 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 J7199?
J7199 is the HCPCS Level II code for hemophilia clotting factor, not otherwise classified. Short descriptor: "Hemophilia clot factor noc".
How much does Medicare pay for J7199?
In 2023, the average Medicare payment was $5.82 per service (average allowed $7.30).
Does Medicare cover J7199?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
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 J7199
- Watch J7199 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J7199
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.