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HCPCS J7214 · Level II · Part B drug

HCPCS J7214: Injection, factor viii/von willebrand factor complex, recombinant (altuviiio),

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for J7214

Billing unit
1 IU
Altuviiio per factor viii iu
ASP payment limit
$4.656
October 2026; +0.5% vs July 2026
Practitioner MUE
7500
MAI 1
OPPS status
SI G
APC 9277
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J7214 is the Level II code for Injection, factor viii/von willebrand factor complex, recombinant (altuviiio),, billed per 1 IU. The Medicare Part B ASP payment limit for October 2026 is $4.656 per billing unit, up 0.5% from July 2026. The practitioner MUE allows up to 7500 units per date of service (MAI 1). Under OPPS it carries status indicator G in APC 9277. J7214 is billed in units of 1 IU; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. The ASP crosswalk maps 6 NDCs to it, sold as Altuviiio by Bioverativ Therapeutics Inc.. No current Billing and Coding Article lists J7214, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J7214 at $4.656 per 1 IU for October 2026, derived from manufacturer average sales price plus 6%, compared with $4.632 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J7214
QuarterPayment limitPerCoinsurance
October 2026$4.6561 IU20%
July 2026$4.6321 IU—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 6 NDCs from 1 labeler to J7214. Report the NDC in the claim's drug segment and bill the number of J7214 units that equals the quantity administered divided by 1 IU; the last column gives units per full package.

NDCs that crosswalk to J7214
NDCDrug nameLabelerPackage sizeBilling units / package
71104-0978-01AltuviiioBioverativ Therapeutics Inc.1 × 11
71104-0979-01AltuviiioBioverativ Therapeutics Inc.1 × 11
71104-0981-01AltuviiioBioverativ Therapeutics Inc.1 × 11
71104-0982-01AltuviiioBioverativ Therapeutics Inc.1 × 11
71104-0983-01AltuviiioBioverativ Therapeutics Inc.1 × 11
71104-0984-01AltuviiioBioverativ Therapeutics Inc.1 × 11

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for J7214. For practitioners the limit is 7500 units per date of service with adjudication indicator 1, a claim-line edit: units above the limit deny on that line, and documented separate services can be reported on another line with an appropriate modifier.

MUE values for J7214 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services75001 Line EditClinical: CMS Workgroup
Facility outpatient hospital96001 Line EditClinical: CMS Workgroup

NCCI edits and add-on relationships

No active practitioner PTP pair lists J7214 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

J7214 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists J7214 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J7214 carries status indicator G and is assigned to APC 9277, with a published national unadjusted payment of $4.63. Status G marks pass-through drug payment, which is time-limited.

Common denials for J7214 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks J7214 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

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Frequently asked questions — HCPCS J7214

What does HCPCS code J7214 describe?

J7214 is defined by CMS as "Injection, factor viii/von willebrand factor complex, recombinant (altuviiio),". Each billing unit represents 1 IU, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J7214 in October 2026?

The ASP-based payment limit is $4.656 per 1 IU, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $4.632.

How many units of J7214 can be billed per day?

The practitioner Medically Unlikely Edit is 7500 units per date of service with adjudication indicator 1 (1 Line Edit). MAI 1 edits apply per claim line; units may be split across lines with an appropriate modifier when justified. CMS cites "Clinical: CMS Workgroup" as the rationale.

Which NDCs map to J7214?

The October 2026 ASP crosswalk lists 6 NDCs from 1 labeler: Altuviiio (Bioverativ Therapeutics Inc.). For example NDC 71104-0978-01 is a 1 package equal to 1 billing unit. The crosswalk's billing-units-per-package figure converts each package into J7214 units.

Does J7214 have NCCI bundling edits?

No active practitioner PTP pairs list J7214 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.