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See a sample rate comparisonHCPCS J7185 (Xyntha) Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Injection, factor VIII (antihemophilic factor, recombinant) (XYNTHA), per IU
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Clotting Factors |
| Common Place of Service | None 99 - Other POS |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J7185 |
| Medicare Payment Limit | $1.673  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J7185 by major payers:
$1.64
$1.75
$1.59
$1.58
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HCPCS J7185
5 of 25 sample ratesHigher to lower in this preview
Eoh Acquisition Group, LLC, Carewell Health Medical Center
Eoh Acquisitions Group, LLC Dba Carewell Health
$2.33Published rateNasiratu Larry
White Plains Hospital Medical Center
$1.57Published rateMeriter Hospital, Inc., Unitypoint Health - Meriter
Meriter Hospital Inc
$1.50Published rateAlameda Health System
$1.48Published rateMobile Infirmary Association, The Infirmary Center For Wound Healing
Mobile Infirmary Association
$1.30Published rate
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See a sample payer proposalHCPCS J7185 vs. Other Clotting Factors Codes
The HCPCS J7185 code is part of the Drugs Administered Other than Oral Method services used for Clotting Factors. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS J7185 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| J7183-HCPCS | Low | Injection, von Willebrand factor complex (human), wilate, 1 IU VWF:RCo |
| J7185-HCPCS | Low | Injection, factor VIII (antihemophilic factor, recombinant) (XYNTHA), per IU |
| J7186-HCPCS | Low | Injection, antihemophilic factor VIII/von Willebrand factor complex (human), per factor VIII IU |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J7185. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J7185 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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