J7186 — Injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u.
J7186 is a HCPCS Level II code for injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii 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: 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 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 J7186 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
- 7500 units MAI 1 — Line Edit · Clinical: CMS Workgroup
- outpatient
- 9600 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 J7186
- Long descriptor
- Injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u.
- Short descriptor
- Antihemophilic viii/vwf comp
- Added
- January 1, 2009
- 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 J7186
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J7186 is not quite right, the correct code is very often within a few positions of it.
- 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
- J7185Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per 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.
- J7194Factor ix, complex, per i.u.
Questions about J7186
What is HCPCS code J7186?
J7186 is a HCPCS Level II code for injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u.. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J7186?
The CMS HCPCS file marks J7186 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 J7186 paid under the physician fee schedule?
J7186 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).