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See a sample rate comparisonHCPCS J7191 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.
Factor VIII (antihemophilic factor (porcine)), per IU
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Clotting Factors |
| Common Place of Service | 11 - Office |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J7191 |
National average reimbursement for HCPCS J7191 by major payers:
$1.90
$1.86
$1.80
$1.99
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HCPCS J7191
5 of 25 sample ratesHigher to lower in this preview
Fairview Health Services, Fairview Diagnostic Laboratory
$3.36Published rateRegions Hospital
Group Health Plan Inc
$2.21Published rateRiverview Hospital
$1.86Published rateTrinitas Regional Medical Center, Trinitas Hospital - Dmi
Rwj Barnabas Health Inc
$1.86Published rateGonzales Healthcare Systems, Memorial Hospital
$0.74Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J7191 vs. Other Clotting Factors Codes
The HCPCS J7191 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 J7191 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 |
|---|---|---|
| J7190-HCPCS | Low | Factor VIII (antihemophilic factor, human) per IU |
| J7191-HCPCS | Low | Factor VIII (antihemophilic factor (porcine)), per IU |
| J7192-HCPCS | Low | Factor VIII (antihemophilic factor, recombinant) per IU, not otherwise specified |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J7191. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J7191 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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