Summary & Overview
HCPCS J7182: Injection, Factor VIII (Recombinant) (NovoEight), per IU
HCPCS Level II code J7182 designates the per-IU billing unit for recombinant factor VIII (antihemophilic factor, recombinant), branded as NovoEight, used for replacement therapy in patients with hemophilia A. Nationally, this code matters because recombinant clotting factors represent a high-cost, high-impact category of specialty injectable medications that drive pharmacy and infusion expenditures and require accurate coding for dosing-based reimbursement and medical necessity validation.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for J7182, typical sites of service where the product is administered, and the types of benchmarks and policy topics commonly associated with high-cost clotting factor products — including billing unit structure, prior authorization and medical necessity considerations, and payer coverage patterns. The publication also outlines related operational issues such as billing per international unit, inventory and waste reporting practices, and where to look for payer-specific guidance.
This summary is intended for healthcare revenue cycle, pharmacy, and clinical policy audiences seeking a national perspective on coding and administrative considerations for recombinant factor VIII therapy billed under J7182.
Billing Code Overview
HCPCS Level II code J7182 describes an injection of factor VIII (antihemophilic factor, recombinant), (NovoEight), billed per international unit (IU). This code represents administration of a recombinant factor VIII product used for replacement therapy in patients with hemophilia A.
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Service type: Medication infusion/injection (recombinant clotting factor replacement)
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Typical site of service: Infusions or injections administered in hospital outpatient infusion centers, ambulatory infusion clinics, physician offices, or home infusion settings where biologic factor replacement is delivered.
Clinical & Coding Specifications
Clinical Context
A male pediatric or adult patient with hemophilia A presents for outpatient or inpatient administration of recombinant antihemophilic factor to prevent or treat bleeding. Typical indications include replacement therapy for spontaneous joint or muscle bleeds, perioperative prophylaxis before invasive procedures, or routine replacement for patients with severe factor VIII deficiency. The clinical workflow begins with assessment of current bleeding symptoms, review of recent factor VIII activity levels and inhibitor testing, verification of the prescribed dose in international units (IU) for J7182 (factor VIII, recombinant), and confirmation of venous access. Pharmacy compounds and dispenses the vial(s) of recombinant factor VIII; nursing performs product verification, reconstitution per manufacturer instructions, dose calculation, and aseptic administration via IV push or short infusion. Documentation includes time, lot number, units administered, site of administration, and any immediate adverse reactions. For outpatient self-infusing patients, education and supplies are provided; for surgical prophylaxis, coordination with the operating team ensures target perioperative factor levels are reached and monitored with follow-up dosing as needed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Not used for billing (reserved) | Rarely applied; generally not used clinically for J-codes |
11 | Professional component | Use when reporting a provider’s professional component related to administration that is separately billable per payer policy |
22 | Increased procedural services | Use when administration requires substantially greater effort (complex dosing, extended infusion time) and documentation supports increased work |
52 | Reduced services | Use when only part of the planned service is performed (partial dose administered) and documented |
53 | Discontinued procedure | Use when administration is started but discontinued due to patient reaction or inability to continue |
62 | Two surgeons | Use if a second qualified provider is required for a complex inpatient infusion procedure per payer rules |
78 | Return to OR following initial procedure | Use if factor administration relates to a subsequent surgical return where the preceding surgery is linked |
80 | Assistant surgeon | Use when an assistant surgeon participates in a procedure that necessitates perioperative factor administration |
JW | Drug discarded/partial dose not administered | Use when part of a vial is discarded and documentation shows wasted units |
JZ | No wastage/entire drug administered | Use when the entire dispensed vial(s) are administered and no wastage occurred |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RC0000X | Hematology & Oncology | Hematologists manage dosing, inhibitor testing, and long-term factor therapy |
207RH0000X | Pediatric Hematology-Oncology | Pediatric specialists provide dosing for infants and children with congenital hemophilia A |
163W00000X | Emergency Medicine | Emergency providers manage acute bleeds and initial factor administration |
208000000X | Internal Medicine | General internists may manage outpatient prophylaxis and coordination of infusions |
364S00000X | Nurse Practitioner | Advanced practice providers often perform assessment and administration in outpatient infusion centers |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
D66 | Hereditary factor VIII deficiency (Hemophilia A) | Primary indication for recombinant factor VIII replacement therapy for prophylaxis and treatment of bleeding |
D68.0 | Von Willebrand disease | Some patients with severe von Willebrand disease receive factor VIII-containing concentrates; clinical overlap may require factor VIII infusions |
T80.7XXA | Infection following infusion, initial encounter | Potential complication of infusion therapy; relevant for monitoring adverse events |
Z79.82 | Long term (current) use of anticoagulants | Relevant when coordinating factor replacement in patients with concurrent anticoagulant therapy to manage bleeding risk |
Z51.89 | Encounter for other specified aftercare | Used for routine follow-up visits associated with infusion-based therapy and long-term management |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
96365 | Intravenous infusion, therapeutic, initial, up to 1 hour | Used when factor VIII is administered as an IV infusion requiring timed infusion monitoring for the first hour |
96366 | Intravenous infusion, each additional hour | Used when infusion of factor VIII extends beyond the first hour and time-based billing applies |
96372 | Therapeutic, prophylactic, or diagnostic injection (SC/IM) | Used if an ancillary medication (e.g., adjunctive supportive injection) is given at the same encounter |
36415 | Collection of venous blood by venipuncture | Used for pre- and post-infusion factor level monitoring and inhibitor testing |
99024 | Postoperative follow-up visit, routine follow-up following surgery | Used for postoperative management when factor VIII was given perioperatively and follow-up assessment is required |