Summary & Overview
HCPCS J7196: Injection, Antithrombin Recombinant, 50 i.u.
HCPCS Level II code J7196 denotes injection of antithrombin recombinant, 50 i.u., an injectable biologic used to restore antithrombin activity in patients needing replacement therapy. Nationally, accurate coding of recombinant antithrombin is important for clinical documentation, drug utilization tracking, and payer reimbursement for high-cost biologic products administered in acute and outpatient infusion settings. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find concise benchmarks for coding and billing practices, a clinical context for when recombinant antithrombin is administered, and an overview of payer coverage considerations and policy updates that commonly affect reimbursement and prior authorization. The publication summarizes typical sites of service and service line implications for hospitals and infusion centers, and highlights common modifier usage patterns and administrative considerations where available. Data not available in the input will be identified as such rather than inferred.
Billing Code Overview
HCPCS Level II code J7196 represents an injectable recombinant antithrombin product supplied in a 50 international unit (i.u.) vial. This code is used to report administration of antithrombin recombinant for patients requiring replacement of antithrombin activity.
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Service type: Parenteral drug administration (injectable biologic)
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Typical site of service: Hospital inpatient or outpatient infusion center, emergency department, or other clinical settings where intravenous or subcutaneous biologic administration is provided.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient with a documented congenital or acquired antithrombin deficiency presents to an infusion center or hospital for therapeutic antithrombin replacement. The patient is typically an adult or pediatric patient who requires intravenous antithrombin concentrate prior to or during high‑risk procedures (for example, cardiopulmonary bypass, major surgery, or delivery), for treatment of thrombotic events unresponsive to standard anticoagulation, or for perioperative management when antithrombin levels are critically low.
The clinical workflow usually includes: baseline laboratory assessment (antithrombin activity or antigen, coagulation studies), verification of indication and dosing by the ordering physician, pharmacy preparation of the recombinant antithrombin product in 50 international unit vials, administration by an experienced nurse via intravenous bolus or infusion, and post‑dose monitoring of antithrombin activity and hemostasis. Documentation includes the product name and NDC, units administered, lot number, route, start/stop times, patient response, and any adverse reactions. Billing uses HCPCS level II code J7196 reported with appropriate modifiers to reflect circumstances of service, waste, or provider/technical splits if applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug amount discarded/not administered to any patient |