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Q4 2026 takes effect Oct 1, 2026. CMS published it early. Dates of service before then use the current release—see the current HCPCS J7199 rate.

HCPCS J7199

Priced under CLFS

J7199 · PFS Q4 2026 · Upcoming

Status X is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS published status X (statutory exclusion) for HCPCS J7199 in the Q4 2026 Physician Fee Schedule, with no national PFS amount. These figures take effect for dates of service beginning Oct 1, 2026. Treat the blank amount as unpriced, not as $0.

PFS status evidence

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 17,154)
Inspect PFS status evidence
Code
J7199
Release
Q4 2026, revision 2
Result
Priced under CLFS

Citations

  • Shows this code’s PFS status (X). Result: Priced under CLFS.

    Physician relative value file (PPRRVU)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.

    Record details PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 17,154)
    hcpcs (col 1)
    J7199
    modifier (col 2)
    blank
    status_code (col 4)
    X

    SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

    Original source file

Plain-text summary

Why is there no national PFS amount for J7199?

Its status indicator is X (statutory exclusion). The statutory definition of physician services does not include this item. Status X is not separately payable under the PFS.

About this code

Hemophilia clot factor noc

Payment considerations Copy link

Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.

Other fee-schedule routing Applies
Other payment indicators (9)

Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, NCCI same-day edits: Does not apply, MUE behavior: Not determined, Contractor pricing: Does not apply.

Why would a Medicare claim for J7199 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

  • Its status indicator is X (statutory exclusion)—The statutory definition of physician services does not include this item. See status indicators

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

Which billing rules and modifiers apply? Copy link

Global period: what J7199's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

Can you bill it with another code? Copy link

Check a pair of codes Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit for the pair.

See every current NCCI pair for J7199 →

How has it changed? Copy link

Rate history by release Copy link

National Office (non-facility) amount for J7199 across quarterly releases.

Release Status Office Facility
Q4 2026 takes effect Oct 1, 2026 X — —
Q3 2026 Jul 1, 2026 – Sep 30, 2026 X — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 X — —
When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

Usage and related codes Copy link

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q4 2026 release (effective October 2026). National baselines use GPCI 1.000 and exclude sequestration. Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. CMS owns the code description shown for HCPCS Level II codes. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 17,154)

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

The citation names the release, so anyone can check it even after CMS publishes a newer one.

HCPCS J7199 National PFS baseline: No national PFS rate (Q4 2026; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/hcpcs/J7199/2026/D