Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3
National · Effective Nov 24, 2022
1 active Medicare policy lists J7212, and 8 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 Nov 24, 2022
8 policies from 6 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 J7212 |
|---|---|---|
| Coagulation Factor VIIa (recombinant)-jncw [Sevenfact]Effective 02/01/2021 - 11/30/2021 | Feb 1, 2021 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Sevenfact (coagulation factor VIIa [recombinant]-jncw) | Dec 1, 2025 | Prior auth requiredInferred from policy title |
| Sevenfact (coagulation factor VIIa [recombinant]-jncw)Effective 03/01/2025 - 11/30/2025 | Nov 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 J7212 |
|---|---|---|
| Factor VIIa, Recombinant (NovoSeven RT, SevenFact); CP.PHAR.220 | 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 J7212 |
|---|---|---|
| Hemophilia Products - Factor VIII (Hemophilia A) and Factor IX (Hemophilia B) with inhibitors, Acquired Hemophilia, Congenital Factor VII Deficiency, and Glanzmann’s Thrombasthenia: Novoseven RT and Sevenfact | 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 J7212 |
|---|---|---|
| Clotting Factors, Coagulant Blood Products, & Other Hemostatics | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J7212 |
|---|---|---|
| Clotting Factors, Coagulant Blood Products, & Other Hemostatics | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J7212 |
|---|---|---|
| Clotting Factors, Coagulant Blood Products, & Other Hemostatics | Oct 1, 2026 | Covered |