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See a sample rate comparisonHCPCS J7199 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.
Hemophilia clotting factor, not otherwise classified
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Clotting Factors |
| Common Place of Service | None 99 - Other POS |
| Complexity Level | Moderate |
National average reimbursement for HCPCS J7199 by major payers:
$225.00
$70.00
$2.20
$5.16
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HCPCS J7199
5 of 25 sample ratesHigher to lower in this preview
Montefiore Mount Vernon Hospital, Montefiore Mount Vernon Professional Billing
Montefiore Mount Vernon Hospital
$64.00Published rateNorth Shore Medical Center, Inc., North Shore Medical Center
$60.00Published rateVariety Children'S Hospital, Nicklaus Children'S Miami Lakes Outpatient Center
Variety Childrens Hospital
$55.00Published rateNorth Shore Medical Center, Inc., North Shore Medical Center
North Shore Medical Center Inc
$35.00Published rateNorth Shore Medical Center, Inc., North Shore Medical Center
$35.00Published rate
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See a sample payer proposalHCPCS J7199 vs. Other Clotting Factors Codes
The HCPCS J7199 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 J7199 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 |
|---|---|---|
| J7198-HCPCS | Low | Anti-inhibitor, per IU |
| J7199-HCPCS | Moderate | Hemophilia clotting factor, not otherwise classified |
| J7200-HCPCS | Low | Injection, factor IX, (antihemophilic factor, recombinant), Rixubis, per IU |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J7199. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J7199 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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