IDELVION J Code: J7202
Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u.
Q4 2026 Medicare Payment Limit for J7202, effective October 1, 2026: $5.491 per HCPCS billing unit, down 0.3% from $5.507. From CMS's final file.
Drug & Product Overview
About IDELVION
Idelvion is a medication aligned to the HCPCS J Code: J7202 for billing, pricing, and reimbursement purposes in the United States. Classified under Hematology, it is administered via the intravenous route and manufactured by CSL Behring.
According to CMS Drug Use Information: This medication is used to prevent or control bleeding in people with little or no factor IX (due to hemophilia B, Christmas disease). Factor IX is a protein (clotting factor) in the blood that works with other clotting factors to help the blood clot and stop bleeding. People with little or no factor IX are at risk for bleeding longer after an injury/surgery or bleeding suddenly (often in the joints/muscle) without an obvious cause. This medication should not be used to treat other types of factor deficiencies (such as factors II, VII, VIII, X) or factor problems (such as inhibitor to factor XIII), to reverse the effects of "blood thinners" (such as warfarin), or to treat bleeding from low levels of liver-dependent clotting factors (due to liver problems).
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. The list of NDCs below is not exhaustive.
| NDC Code | Drug | Manufacturer | Billing Units / Pkg | Package Size |
|---|---|---|---|---|
| 69911-0864-02 | Idelvion | CSL Behring Lengnau AG | 1 | Kit |
| 69911-0865-02 | Idelvion | CSL Behring Lengnau AG | 1 | Kit |
| 69911-0866-02 | Idelvion | CSL Behring Lengnau AG | 1 | Kit |
| 69911-0867-02 | Idelvion | CSL Behring Lengnau AG | 1 | Kit |
| 69911-0869-02 | Idelvion | CSL Behring Lengnau AG | 1 | Kit |
IDELVION Pricing & Reimbursement
National median reimbursement across major commercial payers.
Create an account on PayerPrice for more information →Historical Graphing and Billing Calculator
Log in to calculate billing and reimbursement with live ASP, WAC & AWP pricing.
Login to use the calculator →IDELVION 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 Idelvion (J7202) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →
IDELVION Medically Unlikely Edits (MUE)
The most billing units of J7202 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 →
IDELVION 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.
Login for BuyandBill.com Analytics
Unlock deeper insights with BuyandBill’s Comparative Report!
- Compare ASP, WAC, and AWP across drugs.
- Visualize Drug Price Movement Over Time
- Tailor reports to drug class, manufacturer, or HCPCS Code.
- Compare Biosimilar and 505(b)(2) products.
Frequently Asked Questions
Is there an available Idelvion billing and coding guide?
Are there any available Idelvion patient assistance programs?
Where can I find Idelvion prescribing information?
Where can I find Idelvion side effect information?
Does billing IDELVION require JZ/JW wastage modifiers?
About BuyandBill.com:
The BuyandBill.com team is dedicated to delivering high-quality coding and billing information for office-administered drugs. We continuously research HCPCS-coded medications to expand our resources and ensure data accuracy. Manufacturers: click here to sponsor your medication, and we will ensure the most accurate and detailed information is displayed.
Related Drug Codes
Explore billing, coding, and pricing for drugs related to IDELVION.