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    HCPCS Details

    HCPC J7170
    Short Description Inj., emicizumab-kxwh 0.5 mg
    Long Description Injection, emicizumab-kxwh, 0.5 mg
    Pricing indicator 51
    Coverage code C
    ASC payment group code YY
    BETOS2 code O1E
    Action code N
    Type of service 1
    Effective date 2019-01-01
    Date Added 2019-01-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    50242092001 J7170 Inj., emicizumab-kxwh 0.5 mg HEMLIBRA GENENTECH, INC. 0.5 MG 1 1 60 60
    50242092101 J7170 Inj., emicizumab-kxwh 0.5 mg HEMLIBRA GENENTECH, INC. 0.5 MG 0.4 1 120 120
    50242092201 J7170 Inj., emicizumab-kxwh 0.5 mg HEMLIBRA GENENTECH, INC. 0.5 MG 0.7 1 210 210
    50242092301 J7170 Inj., emicizumab-kxwh 0.5 mg HEMLIBRA GENENTECH, INC. 0.5 MG 1 1 300 300
    The ASP crosswalks are maintained by the Division of Data Analysis and Market Based Pricing to support ASP-based Medicare Part B payments only. The crosswalks are intended to help the public (including entities that submit manufacturer ASP data and providers who bill for drugs) understand which drug products (identified by NDCs) are assigned to which HCPCS billing codes. The crosswalks are not intended to be a comprehensive list of all drugs/NDCs available in the United States. The NDC to HCPCS Crosswalk also includes information on the NDC package size and the number of billable units (as defined by the HCPCS code descriptor). Comments on the file may be sent to [email protected].

    Drug Details

    • Emicizumab-kxwh injection is used to prevent or reduce the frequency of bleeding in adults, children, and infants with hemophilia A (condition in which the blood does not clot normally because of a missing or faulty blood clotting factor). Emicizumab-kxwh is in a class of medications called hemostatic antibodies. It works by acting as a bridge between clotting factors to help your blood clot.