Summary & Overview
HCPCS Level II J7168: Prothrombin Complex Concentrate (Kcentra), per IU Factor IX Activity
HCPCS Level II code J7168 identifies doses of prothrombin complex concentrate (human), Kcentra, billed per international unit of factor IX activity. This code captures administration of a concentrated clotting factor product used for urgent reversal of vitamin K antagonist anticoagulation and management of certain bleeding disorders. Nationally, the code matters because it applies to high-cost, time-sensitive biologic therapy typically used in hospitals and emergency care, with implications for payer coverage policies, utilization management, and facility billing practices.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context for Kcentra use, expected sites of service, common billing considerations, and the types of benchmarks and policy topics that influence coverage and payment. The publication also outlines where to look for payer-specific policy language, prior authorization triggers, and coding guidance relevant to per-unit billing of factor IX activity.
This summary provides a national perspective useful for revenue cycle leaders, pharmacy and therapeutics committees, and clinical teams involved in managing high-acuity coagulation therapy. Data not available in the input is noted where applicable; the focus remains on clinical description, service setting, and the payer landscape that typically governs access and reimbursement for J7168.
Billing Code Overview
HCPCS Level II code J7168 represents prothrombin complex concentrate (human), Kcentra, billed per international unit of factor IX activity. This product is used to provide concentrated vitamin K–dependent clotting factors for rapid reversal of coagulopathy.
Service type: Injectable blood product for coagulation factor replacement.
Typical site of service: Hospital inpatient and outpatient settings, including emergency departments and infusion centers.
Clinical & Coding Specifications
Clinical Context
A typical patient receiving J7168 (Prothrombin complex concentrate, Kcentra, per IU of factor IX activity) is an adult or pediatric patient with acute, clinically significant bleeding due to deficiency or dysfunction of vitamin K–dependent clotting factors or requiring urgent reversal of vitamin K antagonist therapy (e.g., warfarin) prior to an urgent invasive procedure. A realistic scenario: an older adult on chronic warfarin presents to the emergency department with an intracranial hemorrhage on head CT and an elevated INR of 4.5. The clinical workflow includes rapid assessment by emergency medicine and neurosurgery, initiation of intravenous access, baseline labs including coagulation panel, ordering weight-based dosing of J7168 (Kcentra) for factor IX units, administration of Kcentra with concurrent intravenous vitamin K, monitoring for hemostasis and thrombotic complications, and documentation of units administered and patient response. Typical site of service is the hospital inpatient setting, emergency department, or perioperative suite for urgent reversal prior to surgery. Providers commonly involved include emergency medicine physicians, hospitalists, anesthesiologists, hematologists, and surgical teams coordinating dosing and timing of definitive hemostatic interventions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |