J7201 HCPCS code: Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.
J7201 is the HCPCS Level II code for injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.. In 2024 Medicare paid an average of $3.09 per service for J7201 across 15,323,107 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 9000 per day on outpatient hospital claims. Medicare volume rose 24% from 2022 to 2024 (12,394,690 to 15,323,107 services). In 2024, about 51 clinicians billed Medicare for J7201 for 77 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 | 2015-01-01 |
| Last action effective | 2017-01-01 |
Who bills J7201 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 51 |
| Medicare beneficiaries | 77 |
| States with claims | 2 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J7201, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 12,394,690 | 81 | $4.50 | $3.59 |
| 2023 | 16,023,959 | 78 | $3.86 | $3.08 |
| 2024 | 15,323,107 | 77 | $3.87 | $3.09 |
States with the most J7201 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Pennsylvania | 4,990,787 | $2.75 |
| California | 4,182,936 | $2.72 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 9000 | Clinical: CMS Workgroup |
| practitioner claims | 9000 | Clinical: CMS Workgroup |
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 J7201
- 2015-01-01: J7201 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 J7201?
J7201 is the HCPCS Level II code for injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.. Short descriptor: "Factor ix alprolix recomb".
How much does Medicare pay for J7201?
In 2024, the average Medicare payment was $3.09 per service (average allowed $3.87).
Does Medicare cover J7201?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J7201?
Medicare policy articles that cite J7201 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 J7201 can be billed per day?
9000 on outpatient hospital claims; 9000 on practitioner claims (NCCI medically unlikely edits).
Related J72 codes
- J7200 — Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu
- J7202 — Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u.
- J7203 — Injection factor ix, (antihemophilic factor, recombinant), glycopegylated, (rebinyn), 1 iu
- J7204 — Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
- J7205 — Injection, factor viii fc fusion protein (recombinant), per iu
- J7207 — Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u.
- J7208 — Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u.
- J7209 — Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u.
- J7210 — Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u.
- J7211 — Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u.
- J7212 — Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram
- J7213 — Injection, coagulation factor ix (recombinant), ixinity, 1 i.u.
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 J7201
- Watch J7201 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J7201
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.