2025 HCPCS code J7170
Effective Date: N/A Drugs, Administered by Injection Feed
Injection, emicizumab-kxwh, 0.5 mg
Modifiers, such as JW (Drug amount discarded/not administered to any patient), may be applicable.
Medical necessity for emicizumab-kxwh is established by the diagnosis of hemophilia A with factor VIII inhibitors, and the need for routine bleeding prophylaxis. Supporting documentation such as lab results and clinical notes justifying the treatment are crucial.
Administer emicizumab-kxwh subcutaneously at a dosage of 3 mg/kg once weekly for the first 4 weeks, then 1.5 mg/kg once weekly thereafter. The medication is supplied in single-dose vials of 30 mg/mL, 60 mg/0.4 mL, 105 mg/0.7 mL, and 150 mg/mL. Report J7170 for each 0.5 mg unit administered.
In simple words: This code represents an injection of Hemlibra (emicizumab-kxwh), a medication used to prevent bleeding in people with hemophilia A.
One unit of this code represents 0.5 mg of emicizumab–kxwh, a monoclonal antibody, administered by subcutaneous injection to prevent or reduce the frequency of bleeding episodes in adults and children with hemophilia A. This drug is prescribed as routine prophylaxis for adults and children with hemophilia A (congenital factor VIII deficiency) with factor VIII inhibitors.
Example 1: A 20kg child with hemophilia A and factor VIII inhibitors receives their first dose of emicizumab-kxwh. The dose is 3mg/kg, totaling 60mg (120 units of J7170)., After 4 weeks, the same child continues treatment with emicizumab-kxwh, now receiving 1.5 mg/kg weekly. This equates to a 30mg dose (60 units of J7170)., An adult weighing 70kg with hemophilia A and inhibitors begins emicizumab-kxwh. They receive the initial dose of 3mg/kg which is 210mg (420 units of J7170).
Documentation should include the diagnosis of hemophilia A with factor VIII inhibitors, the dosage administered, the route of administration (subcutaneous), and any discarded drug amounts.
** This code includes the clotting factor furnishing fee. Emicizumab-kxwh is a generic drug, with the brand name Hemlibra. As of December 10, 2024, this information is current but subject to change with updates to HCPCS codes.
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