Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3
National · Effective Oct 1, 2026
1 active Medicare policy lists J7201, and 7 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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National · Effective Oct 1, 2026
7 policies from 7 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
| Policy | Effective | Status of J7201 |
|---|---|---|
| Factor IX (e.g., AlphaNine, Alprolix, BeneFIX, Idelvion, Ixinity, Mononine, Profilnine, Rebinyn, Rixubis) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J7201 |
|---|
| Alprolix, BeneFIX, Idelvion, Ixinity, Rebinyn, Rixubis (coagulation factor IX [recombinant]) AlphaNine SD (coagulation factor IX [plasma-derived]) Profilnine (factor IX complex [plasma-derived]) | Aug 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of J7201 |
|---|---|---|
| Hemophilia Products – Factor IX (Hemophilia B): Alphanine SD, Alprolix, Bebulin, Benefix, Idelvion, Ixinity, Mononine, Profilnine, Rebinyn, and Rixubis | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J7201 |
|---|---|---|
| Extended Half-life Factor IX Products: Alprolix, Idelvion, and Rebinyn | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J7201 |
|---|---|---|
| Clotting Factors, Coagulant Blood Products, & Other Hemostatics | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J7201 |
|---|---|---|
| Clotting Factors, Coagulant Blood Products, & Other Hemostatics | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J7201 |
|---|---|---|
| Clotting Factors, Coagulant Blood Products, & Other Hemostatics | Oct 1, 2026 | Covered |