Summary & Overview
HCPCS J7190: Factor VIII (Antihemophilic Factor, Human) per I.U.
HCPCS Level II code J7190 denotes Factor VIII (antihemophilic factor, human) billed per international unit and is used for administration of clotting factor in patients with hemophilia A or acquired factor VIII deficiency. Nationally, this code is important because it captures high-cost, specialty biologic therapy administered in infusion settings and affects coverage, utilization management, and pharmacy-billing workflows across payers.
Key payers evaluated include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines which payers commonly cover factor VIII under medical benefit claims, typical site-of-service patterns (hospital outpatient departments, ambulatory infusion centers, home infusion in selected cases), and payer-specific considerations for authorization and billing.
Readers will find clinical context about the therapy’s indication and administration, benchmark considerations for per-unit billing, typical service lines and places of service, and common procedural and billing nuances related to infusible clotting factor products. Data limitations: where specific payer-level benchmarks, taxonomies, or diagnosis linkage were not provided in the input, the report notes "Data not available in the input." The piece is designed to inform coding, revenue cycle, and clinical teams about the coding purpose and operational implications of J7190 at a national level.
Billing Code Overview
HCPCS Level II code J7190 represents Factor VIII (antihemophilic factor, human) billed per international unit (i.u.). This medication is a plasma-derived or recombinant clotting factor used to treat and prevent bleeding episodes in patients with hemophilia A and other factor VIII deficiencies.
Service Type: Intravenous infusion of a clotting factor
Typical Site of Service: Hospital inpatient or outpatient infusion center; ambulatory infusion clinic; specialty infusion center.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric person with Hemophilia A presenting for inpatient or outpatient intravenous replacement therapy of antihemophilic factor VIII. The patient may be scheduled for routine prophylactic infusion to prevent spontaneous bleeding, treated for an acute bleeding episode (joint, muscle, mucosal, or post‑operative bleeding), or receiving factor replacement perioperatively for a surgical procedure. Care is delivered in settings that include hospital inpatient units, hospital outpatient infusion centers, ambulatory infusion centers, emergency departments, and specialized hemophilia treatment centers. The clinical workflow includes verifying the physician order for J7190 dosed in international units (IU), reviewing weight and recent factor levels, reconstituting the factor VIII product per manufacturer directions, performing venous access (peripheral IV or central venous catheter), administering the calculated IU dose intravenously, monitoring for efficacy and infusion‑related adverse events (allergic reaction, inhibitor development, infusion site complications), documenting lot number and units administered, and updating the medication administration record and billing with the appropriate modifiers for payer adjudication.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | When no special circumstances apply and no additional modifier is required |