J7168 — Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity
J7168 is a HCPCS Level II code for prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity. It belongs to the Drugs Administered Other Than Oral Method section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusE
Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of J7168 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 5000 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- outpatient
- 5000 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for J7168
- Long descriptor
- Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity
- Short descriptor
- Prothrombin complex kcentra
- Added
- July 1, 2021
- BETOS
- O1E
- Pricing indicator
- 51 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Drugs.
Codes adjacent to J7168
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J7168 is not quite right, the correct code is very often within a few positions of it.
- J70605% dextrose/water (500 ml = 1 unit)
- J7070Infusion, d5w, 1000 cc
- J7100Infusion, dextran 40, 500 ml
- J7110Infusion, dextran 75, 500 ml
- J7120Ringers lactate infusion, up to 1000 cc
- J71215% dextrose in lactated ringers infusion, up to 1000 cc
- J7131Hypertonic saline solution, 1 ml
- J7165Injection, prothrombin complex concentrate, human-lans, per i.u. of factor ix activity
- J7169Injection, coagulation factor xa (recombinant), inactivated-zhzo (andexxa), 10 mg
- J7170Injection, emicizumab-kxwh, 0.5 mg
- J7171Injection, adamts13, recombinant-krhn, 10 iu
- J7172Injection, marstacimab-hncq, 0.5 mg
- J7173Injection, concizumab-mtci, 0.5 mg
- J7174Injection, fitusiran, 0.04 mg
- J7175Injection, factor x, (human), 1 i.u.
- J7176Injection, human fibrinogen - chmt (fesilty), 1 mg
Questions about J7168
What is HCPCS code J7168?
J7168 is a HCPCS Level II code for prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J7168?
The CMS HCPCS file marks J7168 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is J7168 paid under the physician fee schedule?
J7168 carries PFS status code E. Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).