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J7165

J7165 – INJECTION, PROTHROMBIN COMPLEX CONCENTRATE, HUMAN-LANS, PER I.U. OF FACT · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 3 NDCs crosswalked

This page is curated, coded, and maintained by

Compiled from public FDA, CMS, DailyMed, NADAC, and related drug data sources. Editorial policy

📋 J7165 summary

J7165 is a HCPCS Level II J-code used to bill PROTHROMBIN COMPLEX CONCENTRATE, HUMAN-LANS, PER I.U. OF FACTOR IX ACTIVITY. The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.

Brand names associated with J7165: Kcentra, Balfaxar

Code J7165 NDC-Crosswalk 3 RxCUI Atlas Trace the drug concept →

⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.

🗂️ Key billing facts

HCPCS codeJ7165
DescriptorINJECTION, PROTHROMBIN COMPLEX CONCENTRATE, HUMAN-LANS, PER I.U. OF FACTOR IX ACTIVITY
Billing unitNot available in current dataset
Payment limit / unit Not available in current dataset
Mapped NDCs3
Data periodNot available in current dataset
Last updatedSource date not available

🧾 Billing & reimbursement HCPCS · CMS

Medicare payment limit / unit
—
Est. ASP / unit
—
Est. after 2% sequester
—
HCPCS dosage
—
The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J7165 = 1 unit. Enter a regimen to convert dose → billing units and project a full course.
Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.

🔁 NDCs that bill under J7165 CROSSWALKED NDCs

3 NDCs map to J7165. Bill units = how many HCPCS units one package represents.
NDC (11-digit)DrugLabelerPackageStrength Bill units NADAC / unit StatusSource
63833-0387-02 Kcentra PROTHROMBIN, COAGULATION FACTOR VII HUMAN, COAGULATION FACTOR IX HUMAN, COAGULATION FACTOR X HUMAN, Protein C, Protein S Human, and Water KIT CSL 1 KIT in 1 CARTON (63833-387-02) * 40 mL... — 1 — ● Active PDAC
68982-0261-01 Balfaxar Prothrombin Complex Concentrate (Human) 25.5 [iU]/mL; 26 [iU]/mL; 16.5 [iU]/mL; 24 [iU]/mL; 22 [iU]/mL; 22 [iU]/mL POWDER, FOR SOLUTION Octapharma 1 VIAL, GLASS in 1 CARTON (68982-261-01)... 25.5 [iU]/mL; 26 [iU]/mL; 16.5 [iU]/mL; 24 [iU]/mL; 22 [iU]/mL; 22 [iU]/mL 1 — ● Active PDAC
68982-0261-02 Balfaxar Prothrombin Complex Concentrate (Human) 25.5 [iU]/mL; 26 [iU]/mL; 16.5 [iU]/mL; 24 [iU]/mL; 22 [iU]/mL; 22 [iU]/mL POWDER, FOR SOLUTION Octapharma 1 VIAL, GLASS in 1 CARTON (68982-261-02)... 25.5 [iU]/mL; 26 [iU]/mL; 16.5 [iU]/mL; 24 [iU]/mL; 22 [iU]/mL; 22 [iU]/mL 1 — ● Active PDAC
NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.

📈 Medicare Part B claims detail CMS PSPS · 2024

Calendar-year 2024 Medicare Part B fee-for-service activity for this HCPCS code, summed across all carriers, localities and specialties (CMS Physician/Supplier Procedure Summary). A “service” is one billed line/unit — not one claim — so counts run higher than claim counts.
Allowed charges
$6.5K
Medicare paid
$5.1K
Submitted services
1,998
Submitted charges
$9.3K
Source: CMS Physician/Supplier Procedure Summary (PSPS), CY2024 — Medicare Part B carrier + DME fee-for-service claims (excludes Medicare Advantage). Figures are for the whole HCPCS code, which may cover uses beyond this drug. ⚠ CMS hides any figure covering fewer than 11 patients (a privacy rule), so totals — especially denials and low-volume codes — run a little low.

🗺️ Where J7165 is utilized

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The geographic utilization map is building for this code — it aggregates millions of CMS Part B claim lines, then caches the result. Refresh in a moment; if it doesn’t appear, this code may have no reportable Part B utilization.

📊 What bills under J7165

J-codes are billing codes often used for drugs billed under the medical benefit. This connects the billing code to the NDC package records it covers, by ingredient and labeler.

NDC products by ingredient
PROTHROMBIN, COAGULATION FACTOR VI... 1
Prothrombin Complex Concentrate (H... 1
NDC products by labeler
CSL Behring GmbH 1
Octapharma USA Inc 1

🗃️ Data sources & freshness

Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.
HCPCS code & descriptor
CMS HCPCS Level II code file
Not available in current dataset
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Not available
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk + DMEPDAC (PDAC)
3 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
Not available for mapped NDCs
Utilization & spend
CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners
No reportable utilization
Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.

⚠️ Practical billing caveats

  • A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
  • Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
  • Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
  • Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
  • The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
  • Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.

❓ J7165 billing FAQ

What is HCPCS code J7165?
J7165 is a HCPCS Level II J-code used to bill INJECTION, PROTHROMBIN COMPLEX CONCENTRATE, HUMAN-LANS, PER I.U. OF FACTOR IX ACTIVITY under Medicare Part B and most medical (not pharmacy) benefits.
Which NDCs bill under J7165?
3 NDCs currently map to J7165 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.
Does a crosswalk mean J7165 is covered?
No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.
For professional billing reference only — verify against the current CMS files before submitting claims.