Submitting the correct Quantity Billed (QB) for hemophilia clotting factors is essential to receiving correct reimbursement. To calculate the correct QB, divide the number if International Units (IUs) administered by 100, and round to the nearest whole number.

Effective July 1, 2009, HCPCS codes for Hemophilia Clotting Factors are J7186, J7187, J7189, J7190, J7191, J7192, J7193, J7194, J7195, J7197, J7198, J7199 and Q2023.

Providers are reminded to report the number of IUs given by following these steps:

• First, divide the number given by 100
• Second, round to the nearest whole number to determine the billing unit
• Fractions from .50 to .99 = 1 additional billing unit
• Fraction from .01 to .49 = NO additional billing unit
• Report the result in the units field of the claim form

Example 1:
A patient received 1232 IU of Factor VIII.

Divide 1232 by 100 (1232/100 = 12.32). Round to the nearest whole number (12). Report the result (0120) in the units field (item 24G) of the claim form.

Example 2:
A patient received 25778 IU of anti-inhibitor coagulant complex.

Divide 25778 by 100 (25778/100 = 257.78). Round to the nearest whole number (258). Report the result (2580) in the units field (item 24G) of the claim form.

Example 3:
A patient received 5798 IU of Factor IX.

Divide 5798 by 100 (5798/100 = 57.98). Round to the nearest whole number (58). Report the result (0580) in the units field (item 24G) of the claim form.

Exception: Not otherwise classified HCPCS code (NOC) J7199.

This code requires the drug name and total IUs submitted (i.e., dosage) in Loop 2300, or 2400, NTE, 02 for electronic claims. For paper claims, submit this information in Item 19 of the CMS-1500 claim form.

Important:
If the calculated QB exceeds the total units indicated below for the specific HCPCS code, the reimbursement amount may be calculated incorrectly. In order to ensure that your reimbursement is correct in these instances, split the service onto two detail lines:

• HCPCS codes J7186, J7187, J7190, J7193, J7194: submit up to 9990 on a single detail line
• HCPCS code J7189: submit up to 7500 on a single detail line
• HCPCS codes J7192 and J7195: submit up to 9000 on a single detail line
• HCPCS code J7197: submit up to 4000 on a single detail line
• HCPCS code J7198: submit up to 6500 on a single detail line
• HCPCS code Q2023: submit up to 8500 on a single detail line
• For charges that exceed $99,999.99 on a single claim refer to the article titled ‘Limits on Billed Amounts: Instructions for Submitting Claims.’

Currently, these large dosages are being submitted by pharmacies.