Summary & Overview
HCPCS J7200: Factor IX (rixubis) Injection, per IU
HCPCS Level II code J7200 denotes administration of recombinant Factor IX (rixubis) billed per international unit. This biologic product is used in the management of hemophilia B to prevent or control bleeding. Nationally, accurate coding of high-cost specialty biologics like J7200 is important for claims processing, clinical documentation, inventory management, and payer coverage determinations.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for Factor IX replacement, common sites of service where J7200 is billed, and the typical service type tied to the code. The publication outlines benchmarks for utilization and billing practices, summarizes relevant policy or coverage considerations affecting claim adjudication, and highlights operational implications for provider billing teams and revenue cycle management.
Data not available in the input is noted where applicable. The content is intended to inform clinical billing staff, revenue cycle professionals, and policy analysts about coding expectations and the administrative context for HCPCS Level II code J7200.
Billing Code Overview
HCPCS Level II code J7200 describes an injection of Factor IX (antihemophilic factor, recombinant), rixubis, per IU. This code represents the billed supply of recombinant Factor IX product measured by international units for treatment of hemophilia B and related coagulation disorders.
Service Type: Therapeutic infusion/injection of clotting factor
Typical Site of Service: Hospital outpatient infusion center, ambulatory infusion clinic, physician office, or other outpatient settings where injectable biologics are administered
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric individual with hemophilia B (congenital factor IX deficiency) presenting for intravenous replacement therapy with recombinant factor IX (J7200). The patient may be receiving routine prophylactic replacement to prevent spontaneous bleeding, on-demand treatment for acute joint or soft-tissue bleeding, or peri-procedural factor replacement for a planned invasive procedure (dental extraction, central line placement, or minor surgery). The clinical workflow includes verification of weight and current factor IX activity levels, review of recent bleeding history and inhibitors, dose calculation in international units (IU) based on body weight and target factor level, preparation of the recombinant product by pharmacy or trained nursing staff, confirmation of IV access, administration over the prescribed infusion time, and post-infusion monitoring for infusion reactions or thrombosis. Documentation elements include diagnosis and indication, calculated IU dose, lot and expiry of the product, route of administration, infusion time, lot-specific modifier if applicable, and any adverse events.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no specific modifier applies to the service |