HCPCS J7182 is officially defined as "Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu." HCPCS J7182 is referenced in 7 tracked payer policy changes from Florida Blue, Humana, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J7182 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Florida Blue Medicare updated its Part B Step Therapy program effective May 15, 2026, adding new non-preferred drugs and changing preferred status for medications in Asthma, Cancer, and Hemophilia categories. Providers must try preferred alternatives before prescribing non-preferred drugs or face coverage denials.
This is a historical policy document (issued 2026-01-01, discovered 2026-10-06) establishing Humana Medicaid Ohio's IVIG (immune globulin) prior authorization requirements across 25 product formulations and 24 clinical indications. The policy specifies preferred products, step-therapy rules, and approval criteria for conditions ranging from primary immunodeficiency to autoimmune diseases. Since this policy became effective on 2026-01-01 and is now 9 months past implementation, verify current applicability with Humana before applying these requirements.
Independence Blue Cross updated policy 08.00.92ak effective 01/01/2026 to add coverage for two new coagulation factor products: Concizumab-mtci (Alhemo) and Fitusiran (Qfitlia) for hemophilia A and B treatment with or without inhibitors. One new HCPCS code (J7174) was added for fitusiran; Concizumab-mtci uses existing unclassified drug codes (C9399, J3590). All ICD-10 diagnosis codes were removed from the policy—providers must report the most appropriate diagnosis code supporting medical necessity.
Independence Blue Cross Medicare Advantage updated policy MA08.004z effective 01/01/2026 to add coverage for two new hemophilia treatment products: Concizumab-mtci (Alhemo) and Fitusiran (Qfitlia). The policy adds HCPCS code J7174 for fitusiran and clarifies that Concizumab-mtci uses unclassified drug codes (C9399, J3590). All ICD-10 diagnosis codes have been removed from the policy; providers must now report the most appropriate diagnosis code based on medical necessity criteria.
This is a revised Factor VIII replacement product prior authorization policy for Hemophilia A treatment, effective January 20, 2017, with most recent updates on December 17, 2025. The policy covers 18 Factor VIII products across two main indications: routine bleeding prophylaxis and on-demand bleeding control/perioperative management. All Factor VIII product requests now require prior authorization approval with specific clinical criteria documentation for Medicaid/Medicare Kentucky members.
Sentara Health Plans' authorization updates effective October 1, 2025 archived several policies, including Deep Brain Stimulation (Surgical 74), Electric Bone Growth Stimulation (DME 09), Near-infrared Spectroscopy (Medical 330) and Home Spirometry (DME 23), with the stimulation policies moved into the new Electrical Stimulation policy (Medical 349). On October 1, 2025, prior authorization became required (Y) for 44 listed procedure codes and for codes including 0420U, 0421U, 0435U, 0212U, 0213U, 81500, 81503, 81528, 88230 and 89420, with some codes directed to OncoHealth or Avalon, and 97161 and 97162 require authorization with benefit limits. Earlier updates effective July 1 and August 1, 2025 removed authorization for codes including 98975, 98976, 98977, 98978, 98980 and 98981, and required authorization for Medicaid codes 0253U, 0254U and 0255U.
Aetna's clotting factor policy applies to commercial medical plans, and the Medicare criteria are set out separately in the Medicare Part B Criteria. Precertification of clotting factors is required of all Aetna participating providers and members in applicable plan designs, and it is requested through Aetna's Special Case Precertification Unit at (855) 888-9046. Clotting factor products must be prescribed by or in consultation with a hematologist, and Aetna considers all other indications experimental, investigational, or unproven.
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