J7213 HCPCS code: Injection, coagulation factor ix (recombinant), ixinity, 1 i.u.
J7213 is the HCPCS Level II code for injection, coagulation factor ix (recombinant), ixinity, 1 i.u.. 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 12000 per day on outpatient hospital claims.
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 | 2023-07-01 |
| Last action effective | 2023-07-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 12000 | Prescribing Information |
| practitioner claims | 12000 | Prescribing Information |
What changed for J7213
- 2023-07-01: J7213 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 J7213?
J7213 is the HCPCS Level II code for injection, coagulation factor ix (recombinant), ixinity, 1 i.u.. Short descriptor: "Inj, ixinity, 1 i.u.".
Does Medicare cover J7213?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J7213 can be billed per day?
12000 on outpatient hospital claims; 12000 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.
- J7211 — Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u.
- J7212 — Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram
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Next steps
- Run a reimbursement report for a device billed under J7213
- Watch J7213 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J7213
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.