J7185 — Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u.
J7185 is a HCPCS Level II code for injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u.. 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 J7185 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 J7185
- Long descriptor
- Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u.
- Short descriptor
- Xyntha inj
- Added
- January 1, 2010
- 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 J7185
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J7185 is not quite right, the correct code is very often within a few positions of it.
- J7176Injection, human fibrinogen - chmt (fesilty), 1 mg
- J7177Injection, human fibrinogen concentrate (fibryga), 1 mg
- J7178Injection, human fibrinogen concentrate, not otherwise specified, 1 mg
- J7179Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco
- J7180Injection, factor xiii (antihemophilic factor, human), 1 i.u.
- J7181Injection, factor xiii a-subunit, (recombinant), per iu
- J7182Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu
- J7183Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco
- 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.
- J7192Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified
- J7193Factor ix (antihemophilic factor, purified, non-recombinant) per i.u.
Questions about J7185
What is HCPCS code J7185?
J7185 is a HCPCS Level II code for injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u.. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J7185?
The CMS HCPCS file marks J7185 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 J7185 paid under the physician fee schedule?
J7185 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).