[Coagulation Factor VIIa (Recombinant)-jncw] Lyophilized Powder for Solution, for Intravenous Use (Sevenfact®) HCPCS Code J7212: Billing Guidelines

Tuesday, January 5, 2021

Effective with date of service Jan 1, 2021, the Medicaid and NC Health Choice programs cover [coagulation factor VIIa (recombinant)-jncw] lyophilized powder for solution, for intravenous use (Sevenfact®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J7212 - Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram.

Strength/Package Size(s): Sevenfact® is available as a lyophilized powder in single-use vials containing 1 or 5 mg of coagulation factor VIIa (recombinant)-jncw. 

Indicated for the treatment and control of bleeding episodes occurring in adults and adolescents (12 years of age and older) with hemophilia A or B with inhibitors. Sevenfact® is not indicated for treatment of congenital factor VII deficiency. 

Recommended Dose (see full prescribing information for further detail): 
For Mild or Moderate Bleeds: 

  • 75 mcg/kg repeated every 3 hours until hemostasis is achieved, OR 
  • Initial dose of 225 mcg/kg. If hemostasis is not achieved within 9 hours, additional 75 mcg/kg doses may be administered every 3 hours as needed to achieve hemostasis.

For Severe Bleeds: 

  • 225 mcg/kg, followed if necessary 6 hours later with 75 mcg/kg every 2 hours 

For Medicaid and NC Health Choice Billing

  • The ICD-10-CM diagnosis code(s) required for billing is/are:  
    • D66 - Hereditary factor VIII deficiency; 
    • D67 - Hereditary factor IX deficiency
  • Providers must bill with HCPCS code: J7212 
  • One Medicaid and NC Health Choice unit of coverage is: 1 microgram  
  • The maximum reimbursement rate per unit is: Providers may contact the North Carolina Pharmacy Help Desk at 800-591-1183 or NCPharmacy@mslc.com and submit their invoice to establish a reimbursement rate.
  • Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs are: 71127-1000-01, 71127-1100-01, 71127-5000-01, 71127-5100-01
  • The NDC units should be reported as “UN1”
  • For additional information, refer to the January 2012 Special Bulletin National Drug Code Implementation Update
  • For additional information regarding NDC claim requirements related to the PADP, refer to the PADP Clinical Coverage Policy 1B, Attachment A, H.7 on Medicaid's website
  • Providers shall bill their usual and customary charge for non-340B drugs
  • PADP reimburses for drugs billed for Medicaid and Health Choice beneficiaries by 340B participating providers who have registered with the Office of Pharmacy Affairs (OPA). Providers billing for 340B drugs shall bill the cost that is reflective of their acquisition cost. Providers shall indicate that a drug was purchased under a 340B purchasing agreement by appending the “UD” modifier on the drug detail.
  • The fee schedule for the PADP is available on Medicaid's PADP web page

Contact

NCTracks Contact Center: 800-688-6696