J7209 HCPCS code: Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u.
J7209 is the HCPCS Level II code for injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u.. In 2024 Medicare paid an average of $1.07 per service for J7209 across 12,232,472 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 7500 per day on outpatient hospital claims. Medicare volume rose 56% from 2022 to 2024 (7,835,217 to 12,232,472 services). In 2024, about 37 clinicians billed Medicare for J7209 for 52 beneficiaries.
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 | 2017-01-01 |
| Last action effective | 2017-01-01 |
Who bills J7209 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 37 |
| Medicare beneficiaries | 52 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J7209, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 7,835,217 | 42 | $1.76 | $1.41 |
| 2023 | 10,995,154 | 57 | $1.62 | $1.29 |
| 2024 | 12,232,472 | 52 | $1.34 | $1.07 |
States with the most J7209 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Illinois | 4,304,510 | $0.98 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 7500 | Clinical: Data |
| practitioner claims | 7500 | 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))
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 J7209
- 2017-01-01: J7209 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 J7209?
J7209 is the HCPCS Level II code for injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u.. Short descriptor: "Factor viii nuwiq recomb 1iu".
How much does Medicare pay for J7209?
In 2024, the average Medicare payment was $1.07 per service (average allowed $1.34).
Does Medicare cover J7209?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J7209?
Medicare policy articles that cite J7209 list 15 covered ICD-10-CM diagnosis codes across 1 article. 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 J7209 can be billed per day?
7500 on outpatient hospital claims; 7500 on practitioner claims (NCCI medically unlikely edits).
Related J72 codes
- J7200 — Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu
- J7201 — Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.
- 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.
- 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.
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Next steps
- Run a reimbursement report for a device billed under J7209
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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.