Summary & Overview
HCPCS J7212: Factor VIIa (recombinant) (Sevenfact), 1 microgram
HCPCS Level II code J7212 designates Factor VIIa (antihemophilic factor, recombinant)-jncw (Sevenfact), billed per 1 microgram unit. This code captures administration or supply of a recombinant hemostatic agent used to treat bleeding episodes in patients with factor deficiencies or certain inhibitor-mediated bleeds. Nationally, precise HCPCS coding for high-cost biologics like recombinant Factor VIIa matters for claims accuracy, utilization tracking, and payer coverage determinations.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and sites of service, payer coverage framing, and commonly used modifiers associated with this HCPCS code. The publication outlines typical billing considerations for injectable recombinant coagulation factors, benchmarks where available, and recent policy or coverage trends relevant to high-cost biologic hemostatic agents.
This summary is intended for billing managers, specialty pharmacy teams, hospital revenue cycle staff, and policy analysts seeking a national-level reference on HCPCS Level II code J7212—what it represents, where it is commonly administered, and which major payers are typically involved in coverage decisions.
Billing Code Overview
HCPCS Level II code J7212 represents Factor VIIa (antihemophilic factor, recombinant)-jncw (Sevenfact), 1 microgram. This itemized supply is a recombinant coagulation factor used to promote hemostasis in patients with bleeding disorders when administration of Factor VIIa is indicated.
Service type: Injectable biologic therapy (recombinant factor)
Typical site of service: Hospital inpatient or outpatient settings, ambulatory infusion centers, and specialty clinics where intravenous or subcutaneous biologic administrations occur.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric individual with congenital hemophilia A or acquired hemophilia presenting with active bleeding or requiring perioperative hemostatic coverage. The patient may arrive to an emergency department, outpatient infusion center, or inpatient hospital setting with joint hemorrhage, soft-tissue bleeding, mucosal bleeding, or scheduled surgical procedure. A hematologist evaluates factor VIIa recombinant therapy for control of bleeding when standard factor VIII replacement is ineffective, contraindicated, or when inhibitor presence requires bypassing agents.
The clinical workflow: after assessment of bleeding severity and review of prior factor therapy and inhibitor status, the hematology team orders J7212 (Factor VIIa recombinant) with dosing per manufacturer and weight-based protocols. Nursing prepares and administers the medication by intravenous bolus or infusion in a monitored setting (ED, infusion center, or inpatient unit). Vital signs and hemostatic response are monitored; repeat dosing is documented as additional units billed by J7212 per microgram increments. Relevant documentation includes indication, dose/units administered, time, route, lot number, informed consent if applicable, and response to therapy. Billing captures the appropriate place of service, modifier(s) to indicate unusual circumstances, and supporting ICD-10 diagnosis codes reflecting the bleeding disorder or indication for bypassing therapy.
Coding Specifications
| Modifier | Description | When to Use |
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