HCPCS J7194: Factor IX, complex, per IU

HCPCS Level II code J7194 represents administration of Factor IX, complex, billed per international unit (IU); this code is used for replacement therapy with Factor IX concentrates typically supplied for intravenous infusion in the treatment of hemophilia B and related factor IX deficiencies and is commonly associated with hospital outpatient infusion centers, ambulatory infusion clinics, and inpatient settings where clotting factor replacement is provided.

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HCPCS J7194: Factor IX, complex, per IU

Customize your policy alerts

Sign up for hcpcs J7194 policy alerts

Get alerted when payer policies referencing J7194 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Clinical & Coding Specifications

Clinical Context

A 28-year-old male with severe hemophilia B (congenital factor IX deficiency) presents to an outpatient infusion center for scheduled replacement therapy with a factor IX concentrate. The patient reports acute joint pain and swelling of the right knee after minor trauma earlier in the day. The hematology team orders intravenous administration of factor IX concentrate dosed per international units to achieve hemostatic levels. Nursing reviews weight-based dosing, verifies the product lot and expiration, confirms venous access, and documents pre-infusion vital signs and inhibitor status. The infusion is administered under observation with post-infusion monitoring for allergic reaction, infusion-related complications, and hemostatic response. Product wastage is documented if any partial vial remains and is handled per payer and facility policy. Typical site of service is an outpatient infusion center, hospital outpatient department, or home infusion under a licensed provider arrangement when appropriate.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Often used for billing the infusion administration time for factor IX when billed separately from the drug code.
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug	Sometimes used by infusion centers for complex biologic infusions when payer policy permits (check payer guidelines).
`96417`	Chemotherapy administration, each additional hour (List separately in addition to code for primary infusion)	Used to report extended infusion time beyond the initial hour when clinically indicated for complex administration.
`99070`	Supplies and materials (e.g., bandages, syringes) provided by the physician over and above those usually included with the office visit	Used to bill for additional supplies used during infusion if the payer allows separate supply charges.
`36415`	Collection of venous blood by venipuncture	Performed before infusion for baseline labs, inhibitor testing, or factor level measurements in the clinical workflow.

Related Modifiers

5 rows

Modifier	Description	When to Use
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207RH0000X	Hematology (Internal Medicine) Physician	An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
363LF0000X	Family Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
282N00000X	General Acute Care Hospital	An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medica…
335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	A supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (…
172V00000X	Community Health Worker	Community health workers (CHW) are lay members of communities who work either for pay or as volunteers in association with the local health care syste…
261QP2300X	Primary Care Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
207RI0011X	Interventional Cardiology Physician	An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and p…

Related ICD-10-CM Codes

26 rows

ICD-10-CM Code	Description
C83.90	Non-follicular (diffuse) lymphoma, unspecified, unspecified site
C85.90	Non-Hodgkin lymphoma, unspecified, unspecified site
D66	Hereditary factor VIII deficiency
D67	Hereditary factor IX deficiency
D68.1	Hereditary factor XI deficiency
D68.2	Hereditary deficiency of other clotting factors
D68.4	Acquired coagulation factor deficiency
D68.8	Other specified coagulation defects
D69.0	Allergic purpura
D69.3	Immune thrombocytopenic purpura

Showing 1–10 of 26

Related Codes

HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

HCPCS Level II J0121: Omadacycline Injection, 1 mg

HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

HCPCS Level II J0122: Injection, eravacycline, 1 mg

HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

HCPCS Level II J0129: Abatacept Injection, 10 mg

HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

HCPCS Level II J0130: Injection abciximab, 10 mg

HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

HCPCS Level II J0131: Injection, Acetaminophen 10 mg

HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

HCPCS Level II J0133: Injection, Acyclovir 5 mg

HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

Showing 1–10 of 991

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Often used for billing the infusion administration time for factor IX when billed separately from the drug code.
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug	Sometimes used by infusion centers for complex biologic infusions when payer policy permits (check payer guidelines).
`96417`	Chemotherapy administration, each additional hour (List separately in addition to code for primary infusion)	Used to report extended infusion time beyond the initial hour when clinically indicated for complex administration.
`99070`	Supplies and materials (e.g., bandages, syringes) provided by the physician over and above those usually included with the office visit	Used to bill for additional supplies used during infusion if the payer allows separate supply charges.
`36415`	Collection of venous blood by venipuncture	Performed before infusion for baseline labs, inhibitor testing, or factor level measurements in the clinical workflow.

Related Modifiers

5 rows

Modifier	Description	When to Use
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207RH0000X	Hematology (Internal Medicine) Physician	An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
363LF0000X	Family Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
282N00000X	General Acute Care Hospital	An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medica…
335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	A supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (…
172V00000X	Community Health Worker	Community health workers (CHW) are lay members of communities who work either for pay or as volunteers in association with the local health care syste…
261QP2300X	Primary Care Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
207RI0011X	Interventional Cardiology Physician	An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and p…

Related ICD-10-CM Codes

26 rows

ICD-10-CM Code	Description
C83.90	Non-follicular (diffuse) lymphoma, unspecified, unspecified site
C85.90	Non-Hodgkin lymphoma, unspecified, unspecified site
D66	Hereditary factor VIII deficiency
D67	Hereditary factor IX deficiency
D68.1	Hereditary factor XI deficiency
D68.2	Hereditary deficiency of other clotting factors
D68.4	Acquired coagulation factor deficiency
D68.8	Other specified coagulation defects
D69.0	Allergic purpura
D69.3	Immune thrombocytopenic purpura

Showing 1–10 of 26

Related Codes

HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

HCPCS Level II J0121: Omadacycline Injection, 1 mg

HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

HCPCS Level II J0122: Injection, eravacycline, 1 mg

HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

HCPCS Level II J0129: Abatacept Injection, 10 mg

HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

HCPCS Level II J0130: Injection abciximab, 10 mg

HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

HCPCS Level II J0131: Injection, Acetaminophen 10 mg

HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

HCPCS Level II J0133: Injection, Acyclovir 5 mg

HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

Showing 1–10 of 991

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

HCPCS J7194: Factor IX, complex, per IU

Sign up for hcpcs J7194 policy alerts

HCPCS J7194: Factor IX, complex, per IU

Sign up for hcpcs J7194 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS code J7194 represent and when is it used?

Which modifiers should be considered when billing J7194 and what do they indicate?

Which administration and supply CPT codes are commonly billed alongside J7194?

What diagnoses and clinical documentation are relevant when administering and billing for J7194?

Where is Factor IX (J7194) typically administered and which payers commonly cover it?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS code J7194 represent and when is it used?

Which modifiers should be considered when billing J7194 and what do they indicate?

Which administration and supply CPT codes are commonly billed alongside J7194?

What diagnoses and clinical documentation are relevant when administering and billing for J7194?

Where is Factor IX (J7194) typically administered and which payers commonly cover it?

References