Summary & Overview
HCPCS J7186: Antihemophilic Factor VIII/vWF Complex Injection
HCPCS Level II code J7186 denotes an injection of antihemophilic factor VIII/von Willebrand factor complex (human), billed per factor VIII international unit. This biologic replacement therapy is clinically important for managing bleeding in patients with von Willebrand disease and related coagulation disorders. Nationally, use of such high-cost biologic clotting factors has implications for specialty pharmacy, infusion services, and payer coverage policies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, site-of-care considerations, and the payer landscape affecting coverage and billing for J7186. The publication summarizes common billing practices and benchmarks where available, highlights policy updates relevant to biologic clotting factors, and outlines clinical scenarios in which this product is typically administered.
This summary is intended for revenue cycle leaders, specialty pharmacy managers, and clinicians involved with infusion and hematology services. Data not available in the input is identified where applicable.
Billing Code Overview
HCPCS Level II code J7186 represents an injection of antihemophilic factor VIII/von Willebrand factor complex (human), billed per factor VIII international unit (I.U.). This product is used in the treatment and prophylaxis of bleeding in patients with von Willebrand disease and other disorders requiring replacement of factor VIII and von Willebrand factor.
Service Type: Biologic replacement therapy / injectable clotting factor
Typical Site of Service: Hospital outpatient infusion center, ambulatory infusion clinic, or other outpatient facility where intravenous or subcutaneous biologic infusions are administered.
Clinical & Coding Specifications
Clinical Context
A 28-year-old female with von Willebrand disease type 2 presents to an infusion center for perioperative hemostatic management prior to elective dental extraction. The hematology team prescribes human antihemophilic factor VIII/von Willebrand factor complex dosed in international units (IU) per factor VIII activity. Nursing reviews weight and recent factor levels, verifies the prescribed IU dose, prepares the product under aseptic technique, documents lot and expiration, and establishes peripheral IV access. The medication is administered intravenously with monitoring for allergic reaction, viral inactivation compliance, and response via serial bleeding assessment and, when indicated, factor VIII activity assays. Post-infusion documentation includes units administered billed as J7186 per factor VIII IU, infusion start/stop times, lot number, and any adverse events. Typical site of service is an outpatient infusion center or hospital outpatient department; inpatient administration can occur for surgical prophylaxis or major bleeding.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default / No modifier required | Use when no other modifier applies; standard billing submission. |
11 |