J7169 Andexxa 10mg HCPCS Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS J7169: Andexxa (Coagulation Factor Xa Recombinant) 10 mg Injection

HCPCS Level II code J7169 designates a 10 mg injection of recombinant, inactivated coagulation factor Xa (andexxa), a specialized reversal agent used in acute management of life-threatening bleeding associated with factor Xa inhibitors. The code is clinically significant nationwide due to its role in emergent care and its high-cost, single-use therapeutic profile that affects hospital formularies, utilization management, and payer coverage policies.

Key payers analyzed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for andexxa use, typical sites of service where the agent is administered, and the payer landscape relevant to coverage and billing for high-cost reversal agents. The publication summarizes benchmark considerations, coding and billing implications for inpatient and emergency use, and recent policy developments affecting access and prior authorization practices.

This analysis helps clinicians, coders, and policy stakeholders understand where J7169 fits into acute care workflows, how major payers approach coverage, and what operational and documentation elements commonly affect reimbursement and utilization.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareJ7169HCPCS Level IIandexxafactor Xa reversalinjectable therapeuticsemergency medicineinpatient carehigh-cost drugreversal agent

Billing Code Overview

HCPCS Level II code J7169 represents an injection of recombinant, inactivated coagulation factor Xa (andexxa) at 10 mg. This product is indicated for the reversal of anticoagulant effects of certain factor Xa inhibitors in acute, life-threatening bleeding situations and other clinical scenarios where rapid factor Xa activity neutralization is required.

Service Type: Therapeutic injection / reversal agent administration

Typical Site of Service: Hospital inpatient and emergency department settings, including intensive care units and perioperative care where urgent reversal of factor Xa inhibitors is needed.

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Clinical & Coding Specifications

Clinical Context

A typical patient is an adult hospitalized for life-threatening bleeding or requiring urgent reversal of factor Xa inhibitor anticoagulation prior to an emergent procedure. The patient may be receiving apixaban, rivaroxaban, or edoxaban and presents with intracranial hemorrhage, major gastrointestinal bleeding, or needs immediate surgical hemostasis. After initial assessment in the emergency department or inpatient ward, the team documents the anticoagulant and last dose time, assesses renal function, obtains baseline coagulation studies, and consults hematology or anesthesia as indicated. The pharmacy prepares J7169 (andexanet alfa) in 10 mg increments; dosing is weight‑ and agent‑based and delivered as an intravenous bolus followed by infusion per product guidelines. The medication is administered in the ED, OR, or ICU with continuous monitoring for thrombotic events and hemostasis. Documentation includes indication, anticoagulant type and dose, time since last dose, dosing regimen of andexanet, lot numbers, expired/unadministered drug discarded (if applicable), and informed consent when feasible.

Coding Specifications

Modifier	Description	When to Use
`JW`	Drug discarded/unused portion	Use when part of the single‑use vial is discarded and documentation supports discarded amount.

HCPCS Level II J1942: Injection, Aripiprazole Lauroxil, 1 mg

HCPCS-J0281-AMINOCAPROIC-ACID-1G-INJECTION

HCPCS J0281: Aminocaproic Acid Injection, 1 Gram

HCPCS-J1944-ARIPIPRAZOLE-LAUROXIL-INJECTION-1MG

HCPCS Level II J1944: Injection, aripiprazole lauroxil (Aristada), 1 mg

HCPCS-J2778-RANIBIZUMAB-0-1-MG-INJECTION

HCPCS J2778: Ranibizumab Injection, 0.1 mg

HCPCS-J7168-PROTHROMBIN-COMPLEX-CONCENTRATE-KCENTRA-PER-IU-FACTOR-IX

HCPCS Level II J7168: Prothrombin Complex Concentrate (Kcentra), per IU Factor IX Activity

HCPCS-J1110-DIHYDROERGOTAMINE-MESYLATE-INJECTION-1MG

HCPCS J1110: Dihydroergotamine Mesylate Injection, 1 mg

HCPCS-J1575-IMMUNE-GLOBULIN-HYALURONIDASE-HYQVIA-SUBCUTANEOUS-INFUSION

HCPCS J1575: Immune Globulin with Hyaluronidase (HyQvia), 100 mg

HCPCS-J0567-CERLIPONASE-ALFA-INJECTION-1MG

HCPCS J0567: Injection, Cerliponase Alfa, 1 mg

HCPCS-J1414-FIDANACOGENE-ELAPARVOVEC-DZKT-THERAPEUTIC-DOSE

HCPCS J1414: Injection of fidanacogene elaparvovec-dzkt, per therapeutic dose

HCPCS-J0690-CEFAZOLIN-500MG-INJECTION

HCPCS Level II J0690: Injection, Cefazolin Sodium, 500 mg

Showing 1–10 of 991

Taxonomy Code	Specialty	Notes
`207K00000X`	Emergency Medicine Physician	Often initiates reversal in ED for life‑threatening bleeding.
`208000000X`	Hematology Physician	Provides guidance on reversal strategy and monitoring for thrombosis.
`207L00000X`	Anesthesiology Physician	Manages perioperative anticoagulation reversal for urgent surgery.
`207P00000X`	Critical Care Medicine Physician	Manages critically ill patients receiving andexanet in ICU settings.
`363A00000X`	Pharmacist	Prepares and documents high‑cost biologic dosing and wastage tracking.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I61.9`	Intracerebral hemorrhage, unspecified	Major intracranial bleeding is a primary indication for urgent reversal of factor Xa inhibitors with andexanet.
`I62.9`	Nontraumatic subarachnoid hemorrhage, unspecified	Subarachnoid bleeding on anticoagulants may prompt administration of andexanet to limit expansion.
`K92.2`	Gastrointestinal hemorrhage, unspecified	Significant GI bleeding while on a factor Xa inhibitor is an indication for reversal therapy.
`D68.9`	Coagulation defect, unspecified	Documented coagulation defects or complex coagulopathy influence reversal decisions and monitoring.
`T45.515A`	Adverse effect of anticoagulants, initial encounter	Use when bleeding is directly attributed to anticoagulant therapy requiring reversal.
`Z98.890`	Other specified postprocedural states	Use when recent procedures and ongoing anticoagulation status impact the need for reversal.
`I85.00`	Esophageal varices with bleeding, unspecified	Variceal bleeding in anticoagulated patients may prompt use of reversal agents prior to interventions.
`N17.9`	Acute kidney failure, unspecified	Renal impairment affects anticoagulant clearance and dosing considerations for reversal therapy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, initial, up to 1 hour	May be used when an andexanet bolus and infusion regimen requires initial IV infusion billing (check payer guidance).
`96366`	Intravenous infusion, each additional hour	May be reported for additional infusion time beyond the initial hour when infusion duration meets CPT criteria.
`36556`	Therapeutic apheresis, plasma exchange, excluding leukapheresis	Sometimes performed in patients on certain anticoagulants when alternative reversal strategies are required; reported when both procedures occur in same episode.
`99285`	Emergency department visit, high severity	Common ED evaluation code for patients presenting with major bleeding requiring urgent reversal with andexanet.
`99100`	Anesthesia for emergency procedures, major operations	May be reported when emergency operative management requiring anesthesia accompanies andexanet administration.
`36415`	Collection of venous blood by venipuncture	Performed to obtain baseline and follow‑up coagulation studies before and after andexanet administration.

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