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See a sample rate comparisonHCPCS J7205 (Eloctate) 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 Fc fusion protein (recombinant), 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 J7205 |
| Medicare Payment Limit | $2.426  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J7205 by major payers:
$2.47
$2.41
$2.52
$2.51
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HCPCS J7205
5 of 25 sample ratesHigher to lower in this preview
UPMC Altoona, Williamsburg Family Practice
UPMC
$3.90Published rateUnion Medical Center, Union Medical Center
$2.43Published rateOur Lady Of The Angels Hospital, Inc., Our Lady Of The Angels Hospital
Our Lady Of The Angels Hospital Inc
$2.33Published rateDallas County Hospital District, Parkland Health
Dallas County Hospital District
$2.33Published rateMary Hitchcock Memorial Hospital
$2.24Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J7205 vs. Other Clotting Factors Codes
The HCPCS J7205 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 J7205 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 |
|---|---|---|
| J7204-HCPCS | Low | Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu |
| J7205-HCPCS | Low | Injection, factor VIII Fc fusion protein (recombinant), per IU |
| J7207-HCPCS | Low | Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J7205. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J7205 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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