Question 1

What is HCPCS code J7201?

Accepted Answer

HCPCS code J7201 is "Factor ix alprolix recomb". Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.

Question 2

What category is J7201 in?

Accepted Answer

J7201 belongs to HCPCS Category J (Drugs Administered Other Than Oral).

Question 3

When should I use HCPCS code J7201?

Accepted Answer

Use J7201 when billing for factor ix alprolix recomb. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

What ICD-10 codes are commonly used with J7201?

Accepted Answer

Common ICD-10 diagnosis codes used with J7201 include: D66 (Hereditary factor VIII deficiency), D67 (Hereditary factor IX deficiency), D68.01 (Von Willebrand disease, type 1), D68.020 (Von Willebrand disease, type 2A). Always ensure proper medical documentation supports the medical necessity for the HCPCS code being billed.

Question 5

Is J7201 covered by Medicare?

Accepted Answer

Coverage for J7201 (Factor ix alprolix recomb) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 6

What documentation is required for J7201?

Accepted Answer

Documentation for J7201 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).