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See a sample rate comparisonHCPCS J7194 (Profilnine) Fee Schedule
Last Verified: October 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 IX, complex, per IU
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Clotting Factors |
| Common Place of Service | None 21 - Inpatient Hospital 11 - Office |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J7194 |
| Medicare Payment Limit | $1.697  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J7194 by major payers:
$1.69
$1.68
$1.73
$1.75
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HCPCS J7194
5 of 25 sample ratesHigher to lower in this preview
North Shore Medical Center, Inc., North Shore Medical Center
$60.00Published rateUPMC Kane
UPMC
$2.76Published rateSaint Joseph'S Hospital, Inc.
Saint Josephs Hospital Inc
$1.75Published rateSmsj Tucson Holdings LLC, St. Marys Hospital
$1.64Published rateEmory Healthcare
Emory University
$1.54Published rate
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See a sample payer proposalHCPCS J7194 vs. Other Clotting Factors Codes
The HCPCS J7194 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 J7194 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 |
|---|---|---|
| J7193-HCPCS | Low | Factor IX (antihemophilic factor, purified, non-recombinant) per IU |
| J7194-HCPCS | Low | Factor IX, complex, per IU |
| J7195-HCPCS | Low | Injection, factor IX (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 J7194. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J7194 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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