J7213 — Injection, coagulation factor ix (recombinant), ixinity, 1 i.u.
J7213 is a HCPCS Level II code for injection, coagulation factor ix (recombinant), ixinity, 1 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 J7213 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
- 12000 units MAI 1 — Line Edit · Prescribing Information
- outpatient
- 12000 units MAI 1 — Line Edit · Prescribing Information
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 J7213
- Long descriptor
- Injection, coagulation factor ix (recombinant), ixinity, 1 i.u.
- Short descriptor
- Inj, ixinity, 1 i.u.
- Added
- July 1, 2023
- 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 J7213
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J7213 is not quite right, the correct code is very often within a few positions of it.
- J7204Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
- J7205Injection, factor viii fc fusion protein (recombinant), 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
- J7214Injection, factor viii/von willebrand factor complex, recombinant (altuviiio), per factor viii i.u.
- J7294Segesterone acetate and ethinyl estradiol 0.15mg, 0.013mg per 24 hours; yearly vaginal system, each
- J7295Ethinyl estradiol and etonogestrel 0.015mg, 0.12mg per 24 hours; monthly vaginal ring, each
- J7296Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg
- J7297Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg
- J7298Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg
- J7299Intrauterine copper contraceptive (miudella)
- J7300Intrauterine copper contraceptive (paragard)
Questions about J7213
What is HCPCS code J7213?
J7213 is a HCPCS Level II code for injection, coagulation factor ix (recombinant), ixinity, 1 i.u.. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J7213?
The CMS HCPCS file marks J7213 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 J7213 paid under the physician fee schedule?
J7213 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).