J7192 — Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified
J7192 is a HCPCS Level II code for factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified. It belongs to the Drugs Administered Other Than Oral Method section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
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 statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
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 J7192 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
- 22000 units MAI 1 — Line Edit · Clinical: Data
- outpatient
- 22000 units MAI 1 — Line Edit · Clinical: Data
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 J7192
- Long descriptor
- Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified
- Short descriptor
- Factor viii recombinant nos
- Added
- January 1, 1994
- 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 J7192
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J7192 is not quite right, the correct code is very often within a few positions of it.
- J7183Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco
- J7185Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u.
- J7186Injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u.
- J7187Injection, von willebrand factor complex (humate-p), per iu vwf:rco
- J7188Injection, factor viii (antihemophilic factor, recombinant), (obizur), per i.u.
- J7189Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram
- J7190Factor viii (antihemophilic factor, human) per i.u.
- J7191Factor viii (antihemophilic factor (porcine)), per i.u.
- J7193Factor ix (antihemophilic factor, purified, non-recombinant) per i.u.
- J7194Factor ix, complex, per i.u.
- J7195Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified
- J7196Injection, antithrombin recombinant, 50 i.u.
- J7197Antithrombin iii (human), per i.u.
- J7198Anti-inhibitor, per i.u.
- J7199Hemophilia clotting factor, not otherwise classified
- J7200Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu
Questions about J7192
What is HCPCS code J7192?
J7192 is a HCPCS Level II code for factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J7192?
The CMS HCPCS file marks J7192 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is J7192 paid under the physician fee schedule?
J7192 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.