J7211 HCPCS code: Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u.
J7211 is the HCPCS Level II code for injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u.. In 2024 Medicare paid an average of $1.36 per service for J7211 across 8,128,737 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 22000 per day on outpatient hospital claims. Medicare volume rose 152% from 2022 to 2024 (3,228,929 to 8,128,737 services). In 2024, about 42 clinicians billed Medicare for J7211 for 84 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 | 2018-01-01 |
| Last action effective | 2018-01-01 |
Who bills J7211 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 42 |
| Medicare beneficiaries | 84 |
| States with claims | 2 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J7211, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 3,228,929 | 41 | $1.84 | $1.47 |
| 2023 | 5,326,812 | 75 | $2.02 | $1.61 |
| 2024 | 8,128,737 | 84 | $1.71 | $1.36 |
States with the most J7211 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Pennsylvania | 983,289 | $1.13 |
| Georgia | 19,323 | $34.09 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 22000 | Clinical: CMS Workgroup |
| practitioner claims | 22000 | 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 J7211
- 2018-01-01: J7211 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 J7211?
J7211 is the HCPCS Level II code for injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u.. Short descriptor: "Inj, kovaltry, 1 i.u.".
How much does Medicare pay for J7211?
In 2024, the average Medicare payment was $1.36 per service (average allowed $1.71).
Does Medicare cover J7211?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J7211?
Medicare policy articles that cite J7211 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 J7211 can be billed per day?
22000 on outpatient hospital claims; 22000 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.
- J7209 — Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u.
- J7210 — Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 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 J7211
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Sources: CMS HCPCS Level II release October 2026; 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.