J7195 — Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified
J7195 is a HCPCS Level II code for injection, factor ix (antihemophilic factor, recombinant) per iu, 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 J7195 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
- 6000 units MAI 1 — Line Edit · Clinical: CMS Workgroup
- outpatient
- 20000 units MAI 1 — Line Edit · Clinical: CMS Workgroup
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 J7195
- Long descriptor
- Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified
- Short descriptor
- Factor ix recombinant nos
- Added
- January 1, 2002
- 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 J7195
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J7195 is not quite right, the correct code is very often within a few positions of it.
- 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.
- J7192Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified
- J7193Factor ix (antihemophilic factor, purified, non-recombinant) per i.u.
- J7194Factor ix, complex, per i.u.
- 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
- J7201Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.
- J7202Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u.
- J7203Injection factor ix, (antihemophilic factor, recombinant), glycopegylated, (rebinyn), 1 iu
Questions about J7195
What is HCPCS code J7195?
J7195 is a HCPCS Level II code for injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J7195?
The CMS HCPCS file marks J7195 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 J7195 paid under the physician fee schedule?
J7195 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.