Summary & Overview
HCPCS Level II J7189: Factor VIIa (recombinant), NovoSeven RT, 1 mcg
HCPCS Level II code J7189 identifies recombinant activated Factor VII (NovoSeven RT) at the unit level of 1 microgram. This biologic is used to achieve hemostasis in patients with bleeding disorders, including certain hemophilias and bleeding associated with inhibitors. Nationally, the code matters because unit-based billing of high-cost biologics affects hospital and outpatient drug expense reporting, prior authorization processes, 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 for use of recombinant Factor VIIa, typical sites of service where the product is administered, and the billing mechanics tied to a unit-based HCPCS Level II drug code.
The publication provides benchmarks for unit reporting and utilization patterns where available, summarizes common payer considerations such as coverage and prior authorization trends, and outlines policy and billing practice implications for facilities and providers. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J7189 represents Factor VIIa (antihemophilic factor, recombinant), (NovoSeven RT), 1 microgram. This code indicates administration of a recombinant activated factor VII product used to promote hemostasis in patients with certain bleeding disorders.
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Service Type: Therapeutic biologic administration
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Typical Site of Service: Hospital inpatient, hospital outpatient, emergency department, or other settings where intravenous biologic agents are administered
Clinical & Coding Specifications
Clinical Context
A 45-year-old male with acquired hemophilia A presents to the emergency department with spontaneous soft tissue bleeding and a prolonged activated partial thromboplastin time (aPTT). The hematology team orders hemostatic therapy with recombinant activated factor VII, J7189 (Novoseven RT) dosed in microgram increments per weight and bleeding severity. The clinical workflow includes intravenous preparation by pharmacy, verification of dose and lot, bedside administration by an RN in the ED or inpatient unit, vital sign monitoring during and after infusion, documentation of dose administered in the medication administration record, and follow-up hematology orders for laboratory monitoring (bleeding control, hemoglobin/hematocrit) and repeat dosing as clinically indicated. Typical sites of service include the emergency department, inpatient hospital ward, intensive care unit, and outpatient infusion centers for refractory bleeding or perioperative hemostasis in at-risk patients.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard billing | Use when no additional modifier applies and the drug is billed as routine. |
62 |