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J7186

J7186 – Injection, antihemophilic factor viii/von willebrand factor complex (hum · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 5 NDCs crosswalked per PER FACTOR VIII IU $1.269/unit ASP+6%

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

📋 J7186 summary

J7186 is a HCPCS Level II J-code used to bill antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u., billed per PER FACTOR VIII IU. 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 J7186: Alphanate

Code J7186 Billing unit PER FACTOR VIII IU Payment limit $1.269/unit NDC-Crosswalk 5 Quarter Q3 2026 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 codeJ7186
DescriptorInjection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u.
Billing unitPER FACTOR VIII IU
Payment limit / unit$1.269
Est. ASP / unit$1.197 est.
Mapped NDCs5
Data periodQ3 2026
Last updated2026-08-20

🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026

📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$1.269
Est. ASP / unit
$1.197 est.
Est. after 2% sequester
$1.244
HCPCS dosage
PER FACTOR VIII IU
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), Q3 2026.
Full HCPCS code details (official CMS record)
Long descriptionInjection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u.
CoverageD — Special coverage instructions apply
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment groupYY
Action codeN — No maintenance this year
Effective date2009-01-01
Date added2009-01-01
Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J7186 = 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 J7186 WITH EST. MEDICARE PAY

5 NDCs map to J7186. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($1.269/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
68516-4616-01 Alphanate Antihemophilic Factor/von Willebrand Factor Complex (Human) KIT GRIFOLS 1 KIT in 1 CARTON (68516-4616-1) * 5 mL... — 1 $1.27 — ● Active CMS ASP
68516-4617-01 Alphanate Antihemophilic Factor/von Willebrand Factor Complex (Human) KIT GRIFOLS 1 KIT in 1 CARTON (68516-4617-1) * 5 mL... — 1 $1.27 — ● Active CMS ASP
68516-4618-02 Alphanate Antihemophilic Factor/von Willebrand Factor Complex (Human) KIT GRIFOLS 1 KIT in 1 CARTON (68516-4618-2) * 10 mL... — 1 $1.27 — ● Active CMS ASP
68516-4619-02 Alphanate Antihemophilic Factor/von Willebrand Factor Complex (Human) KIT GRIFOLS 1 KIT in 1 CARTON (68516-4619-2) * 10 mL... — 1 $1.27 — ● Active CMS ASP
68516-4620-02 Alphanate Antihemophilic Factor/von Willebrand Factor Complex (Human) KIT GRIFOLS 1 KIT in 1 CARTON (68516-4620-2) * 10 mL... — 1 $1.27 — ● Active CMS ASP
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 utilization & spend CMS · PART B · 2026 (Q1)

Period
Total Part B spend
$474.9K
Claims
32
Beneficiaries
14
Spend / beneficiary
$33,919.74
Spend / claim
$14,839.88
Trend by period
Where J7186 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #445 of 824
#440 IXEMPRA J9207 $507.9K #441 SIGNIFOR LAR J2502 $497.3K #442 REEVA, PER SQ CM** Q4314 $496.6K #443 FLUOROURACIL J9190 $492.3K #444 BIO-CONNEKT PER SQUA... Q4161 $490.4K #445 ALPHANATE J7186 $474.9K #446 EPICORD 1 SQ CM** Q4187 $473.8K #447 GEMCITABINE HCL(J920... J9201 $466.6K #448 BERINERT J0597 $461.9K #449 FIASP PUMPCART* J1811 $460.5K #450 AMNIOEXCEL BIODEXCEL... Q4137 $457.8K
Total claims — #736 of 824
#731 ZEMDRI J0291 33 #732 DOXY 100* J1271 33 #733 HALOPERIDOL LACTATE J1630 33 #734 APHEXDA J2277 33 #735 STREPTOMYCIN SULFATE J3000 32 #736 ALPHANATE J7186 32 #737 ELZONRIS J9269 32 #738 TEPADINA(J9342)* J9342 32 #739 ERZOFRI J2428 31 #740 TIGAN J3250 31 #741 LEVOTHYROXINE SODIUM... J0650 30

Full breakdown by period (2)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2026 (Q1) $474.9K 14 32 $33,919.74 $14,839.88
2025 (Q1-Q4) $2.35M 31 103 $75,671.43 $22,774.90
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.

📈 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
$2.26M
Medicare paid
$1.74M
Submitted services
795,479
Denial rate
7.7%
Allowed / service
$3.08
Submitted charges
$4.01M
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 J7186 is utilized

⏳
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.

🗃️ 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
Loaded
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Q3 2026 · as of 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk
5 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
Latest data year 2026
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.

❓ J7186 billing FAQ

What is HCPCS code J7186?
J7186 is a HCPCS Level II J-code used to bill Injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u. under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J7186?
One unit of J7186 represents PER FACTOR VIII IU. Report the number of units equal to the dose administered divided by PER FACTOR VIII IU.
How many units of J7186 should I bill?
Divide the dose administered by the code's unit size (PER FACTOR VIII IU) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for J7186?
The Medicare Part B payment limit is $1.269 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $1.244 per unit. Payment limits are revised quarterly.
Which NDCs bill under J7186?
5 NDCs currently map to J7186 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 J7186 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.