HCPCS J7214: Recombinant Factor VIII/vWF Complex (Altuviiio), per IU - OpenPayer

Summary & Overview

HCPCS J7214: Recombinant Factor VIII/vWF Complex (Altuviiio), per IU

HCPCS Level II code J7214 identifies the injectable recombinant factor VIII/von Willebrand factor complex (Altuviiio), billed per factor VIII international unit. This biologic therapy is central to management of factor VIII deficiency and von Willebrand disease for prevention and control of bleeding, making it a high-impact code for hematology, infusion centers, and hospital pharmacies nationwide. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare.

Readers will find a concise overview of clinical context and common sites of service, plus payer coverage considerations and typical billing practices for per-IU dosing. The publication covers benchmarks for utilization and reimbursement trends where available, relevant policy updates affecting biologic factor products, and operational implications for infusion clinics and hospital billing departments. It also summarizes common modifiers and coding nuances to watch for when billing per-IU biologic clotting factors.

Data not available in the input is noted where applicable; the content focuses on nationally relevant policy and billing context rather than state-specific rules.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareJ7214HCPCS Level IIfactor VIIIvon Willebrandinfusion therapybiologichematologyinjectablepharmacy billing

Billing Code Overview

HCPCS Level II code J7214 describes the provision of a recombinant factor VIII/von Willebrand factor complex (brand name Altuviiio) administered by injection, billed per factor VIII international unit (IU). This code represents a biologic clotting factor used in the treatment and prevention of bleeding in people with factor VIII deficiency and von Willebrand disease who require replacement therapy.

Service type: Injectable biologic replacement therapy
Typical site of service: Hospital inpatient or outpatient infusion center, ambulatory infusion suite, or physician office with infusion capabilities

Clinical & Coding Specifications

Clinical Context

A 28-year-old male with severe hemophilia A presents to the outpatient infusion center for scheduled replacement therapy with recombinant factor VIII/von Willebrand factor complex (J7214) following a minor traumatic joint bleed in the right knee. The patient arrives with an order from the hematologist specifying a weight-based dose expressed in factor VIII international units. The clinical workflow includes nurse verification of identity and prescription, baseline vital signs and assessment of the bleeding site, reconstitution and dose calculation of J7214, administration via intravenous push or infusion through a peripheral IV or central venous access device, and post-infusion observation for infusion reactions or inhibitor-related issues. Documentation includes lot number, units administered, route, site, start and stop times, and any adverse events. Billing captures the unit-based J7214 charge with appropriate modifiers for situations such as partial administration, discarded drug (JW) for wastage, or billing for the supervising physician vs. facility. Typical sites of service are outpatient infusion centers, hospital outpatient departments, emergency departments for acute bleeds, and home infusion when appropriate. The typical patient scenario includes prophylactic replacement or on-demand treatment for bleeding episodes in patients with hemophilia A or von Willebrand disease variants requiring factor VIII activity replacement.

Coding Specifications

Modifier	Description	When to Use

Related Codes

HCPCS-J1812-INSULIN-FIASP-PER-5-UNITS

HCPCS J1812: Insulin (Fiasp), per 5 units

HCPCS-J3397-VESTRONIDASE-ALFA-INJECTION

HCPCS Level II J3397: Injection, vestronidase alfa-vjbk, 1 mg

HCPCS-J7345-AMINOLEVULINIC-ACID-TOPICAL-10-PERCENT-GEL

HCPCS J7345: Aminolevulinic Acid HCl 10% Topical Gel, 10 mg

HCPCS-J3145-TESTOSTERONE-UNDECANOATE-INJECTION

HCPCS J3145: Injection, Testosterone Undecanoate, 1 mg

HCPCS-J1570-GANCICLOVIR-500MG-INJECTION

HCPCS J1570: Injection, ganciclovir sodium 500 mg

HCPCS-J2291-NAFCILLIN-INJECTION-20MG

HCPCS Level II J2291: Nafcillin Sodium Injection, 20 mg

HCPCS-J0565-BEZLOTOXUMAB-INJECTION-PREVENT-C-DIFFICILE-RECURRENCE

HCPCS J0565: Injection, bezlotoxumab, 10 mg

HCPCS-J1305-EVINACUMAB-INJECTION-5MG

HCPCS J1305: Evinacumab-dgnb Injection, 5 mg

HCPCS-J2175-MEPERIDINE-INJECTION-100MG

HCPCS J2175: Injection, Meperidine Hydrochloride, per 100 mg

HCPCS-J0480-BASILIXIMAB-INJECTION-20MG

HCPCS J0480: Basiliximab Injection, 20 mg

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Taxonomy Code	Specialty	Notes
`207RH0000X`	Hematology	Hematologists order and manage factor replacement therapy for bleeding disorders
`364SP0800X`	Infusion Therapy	Infusion-certified nurses/infusion specialists administer and monitor factor infusions in ambulatory settings
`207Q00000X`	Hematology/Oncology	Specialists managing complex bleeding, inhibitors, and perioperative factor management
`1835S0402X`	Pharmacy	Clinical pharmacists prepare, calculate dosing, and verify factor VIII products
`261QM0800X`	Nurse Practitioner	Advanced practice providers who may order and supervise outpatient infusions

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D66`	Hereditary factor VIII deficiency (hemophilia A)	Primary indication for factor VIII replacement with `J7214` for prophylaxis or treatment of bleeding
`D68.0`	Hereditary factor deficiency	Broader category that may include factor VIII deficiency presentations requiring replacement therapy
`R58`	Hemorrhage, not elsewhere classified	Acute bleeding episodes where factor replacement is indicated to control bleeding
`M25.561`	Pain in right knee	Common presenting complaint for hemarthrosis in patients with hemophilia treated with factor VIII replacement
`Z79.01`	Long term (current) use of anticoagulants	Relevant as a medication history item that affects bleeding risk and factor replacement planning

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial drug	Used in some infusion centers to describe time-based IV infusion administration of a biologic product like factor when infusion time qualifies
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Used when factor VIII is administered subcutaneously in investigational or specialized situations (rare) or for documentation of simple injection events in non-IV routes if applicable
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Used when billing for time-based IV infusion setup and monitoring alongside the drug HCPCS units in facility settings
`36415`	Collection of venous blood by venipuncture	Performed for baseline labs such as factor level, inhibitor testing, or monitoring post-infusion
`96374`	Therapeutic, prophylactic, or diagnostic injection; each additional sequential infusion (different drug)	Used if multiple sequential infusions or medications are administered during the same encounter alongside `J7214`

`JW`	Drug discarded/not administered to any patient	When part of the vial(s) were discarded and the discarded amount is billed separately per payer policy
`JZ`	Drug/biological administered as single-dose vial with no wastage	When the entire dispensed amount was administered and no wastage occurred
`52`	Reduced services	When an ordered infusion was partially completed and therapeutic effect was reduced
`53`	Discontinued procedure	When infusion was started but stopped due to a clinical complication (e.g., severe allergic reaction)
`76`	Repeat procedure by same practitioner	If a subsequent injection is required during the same encounter and billed separately
`78`	Unplanned return to the operating/procedure room by same physician following initial procedure	Rare for infusion but used if patient needs urgent re-intervention related to the infusion during same admission
`80`	Assistant at surgery	Generally not applicable but present on the list; used when an assistant performs billable activities during a procedure-associated admission
`22`	Increased procedural services	When administration requires substantially greater resources or time than usual (document rationale)
`23`	Unusual anesthesia	If the infusion required administration under general anesthesia in an unusual circumstance
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare beneficiaries	When an eligible non-physician practitioner furnishes the infusion under Medicare rules