J7205 — Injection, factor viii fc fusion protein (recombinant), per iu
J7205 is a HCPCS Level II code for injection, factor viii fc fusion protein (recombinant), per iu. 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 J7205 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
- 9750 units MAI 1 — Line Edit · Clinical: Data
- outpatient
- 9750 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 J7205
- Long descriptor
- Injection, factor viii fc fusion protein (recombinant), per iu
- Short descriptor
- Factor viii fc fusion recomb
- Added
- January 1, 2016
- 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 J7205
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J7205 is not quite right, the correct code is very often within a few positions of it.
- 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
- J7204Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
- J7207Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u.
- J7208Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u.
- J7209Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u.
- J7210Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u.
- J7211Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u.
- J7212Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram
- J7213Injection, coagulation factor ix (recombinant), ixinity, 1 i.u.
- J7214Injection, factor viii/von willebrand factor complex, recombinant (altuviiio), per factor viii i.u.
Questions about J7205
What is HCPCS code J7205?
J7205 is a HCPCS Level II code for injection, factor viii fc fusion protein (recombinant), per iu. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J7205?
The CMS HCPCS file marks J7205 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 J7205 paid under the physician fee schedule?
J7205 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).