ESPEROCT J Code: J7204
Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
Q4 2026 Medicare Payment Limit for J7204, effective October 1, 2026: $2.363 per HCPCS billing unit, up 2.9% from $2.296. From CMS's final file.
Drug & Product Overview
About ESPEROCT
Esperoct is a medication aligned to the HCPCS J Code: J7204 for billing, pricing, and reimbursement purposes in the United States. It is a Hematology drug administered via the intravenous route and manufactured by Novo Nordisk.
According to CMS Drug Use Information: This medication is used to control and prevent bleeding episodes in people with low levels of factor VIII (hemophilia A). It is also used in these patients before surgery to prevent bleeding. People with low factor VIII levels are at risk for bleeding longer after an injury/surgery and for bleeding inside the body (especially into the joints and muscles). This product contains a man-made form of factor VIII, also called antihemophilic factor. This product is used to temporarily replace the missing factor VIII, a protein (clotting factor) that is normally in the blood, so that the blood can clot and the bleeding can stop. This medication should not be used to treat von Willebrand disease.
Disclaimer: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your healthcare professional.
NDC Code Information
Based on publicly available CMS files. Showing 5 of 11 NDCs — log in for the full crosswalk.
| NDC Code | Drug | Manufacturer | Billing Units / Pkg | Package Size |
|---|---|---|---|---|
| 00169-8100-01 | Esperoct | Novo Nordisk | 1 | Kit |
| 00169-8150-01 | Esperoct | Novo Nordisk | 1 | Kit |
| 00169-8200-01 | Esperoct | Novo Nordisk | 1 | Kit |
| 00169-8300-01 | Esperoct | Novo Nordisk | 1 | Kit |
| 00169-8400-01 | Esperoct | Novo Nordisk | 1 | Kit |
| •••••-••••-•• Log in to view | ESPEROCT | •••••••••••• Log in to view | •••• Log in to view | ••• •• / • •• Log in to view |
| •••••-••••-•• Log in to view | ESPEROCT | •••••••••••• Log in to view | •••• Log in to view | ••• •• / • •• Log in to view |
| •••••-••••-•• Log in to view | ESPEROCT | •••••••••••• Log in to view | •••• Log in to view | ••• •• / • •• Log in to view |
ESPEROCT Pricing & Reimbursement
National median reimbursement across major commercial payers.
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Login to use the calculator →ESPEROCT CPT Administration Codes
The below list of CPT codes is intended for informational purposes only and may not be exhaustive. CPT® codes and descriptions are copyright American Medical Association (AMA). All rights reserved.
| CPT Code | Description |
|---|---|
| 96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour |
| 96366 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) |
CMS has identified Esperoct (J7204) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →
ESPEROCT Medically Unlikely Edits (MUE)
The most billing units of J7204 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 iu.
MAI 1 · Line Edit. Per-line limit: units are checked per claim line; medically necessary units beyond the limit may be billable on separate lines with appropriate modifiers. See all MUE limits →
ESPEROCT Clinical Information
Indications and drug classification.
This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.
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Frequently Asked Questions
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Does billing ESPEROCT require JZ/JW wastage modifiers?
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