BALFAXAR J Code: J7165

Drug & Product Overview

HCPCS Descriptor Injection, prothrombin complex concentrate, human-lans, per i.u. of factor ix activity

HCPCS Added Date April 1, 2024

Manufacturer Octapharma

Route of Administration Intravenous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Powder, For Solution

About BALFAXAR

Balfaxar is a medication aligned to the HCPCS J Code: J7165 for billing, pricing, and reimbursement purposes in the United States. It is a Hematology drug administered via the intravenous route and manufactured by Octapharma.

Manufacturers, reach out to us to add more information.

NDC Code Information

4 NDC packages are crosswalked to J7165. Package detail is available to logged-in subscribers.

NDC Code	Drug	Manufacturer	Billing Units / Pkg	Package Size
•••••-••••-•• Log in to view	BALFAXAR
	BALFAXAR
	BALFAXAR
	BALFAXAR

Login to view 4 NDC packages View pricing, complete NDC-to-HCPCS alignments, and package details.

Login →

BALFAXAR Pricing & Reimbursement

J7165 Private Payer Reimbursement

$3.23 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

Create an account on PayerPrice for more information →

BALFAXAR CPT Administration Codes

CPT Code	Description
96365	Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
96366	Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)

Not on the CMS JW / JZ list

This product is new and does not yet appear on the CMS list of HCPCS pertaining to single-dose containers. Wastage billing guide →

BALFAXAR Medically Unlikely Edits (MUE)

The most billing units of J7165 Medicare will pay for one patient in one day, as published by CMS. 1 unit = per factor ix iu.

Practitioner Office & Hospital Outpatient

5,000 units / day

Same limit in both settings

MAI 3 · Date of Service Edit: Clinical. Per-day limit based on clinical expectations; excess units are denied but may be appealed with documentation of medical necessity. See all MUE limits →

BALFAXAR Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.

Urgent reversal of acquired coagulation factor deficiency induced by vitamin K antagonist (e.g., warfarin) therapy in adults needing urgent surgery or an invasive procedure

Drug Class

Anti-coagulant [EPC]Blood Coagulation Factor [EPC]Blood Coagulation Factors [CS]Decreased Coagulation Factor Activity [PE]Enzyme Precursors [CS]Human Blood Coagulation Factor [EPC]Increased Coagulation Activity [PE]Protein C [CS]

Frequently Asked Questions

Is a Balfaxar billing and coding guide available?

Billing and coding information for BALFAXAR can be found through Octapharma. Visit Here →

Is Balfaxar patient assistance information available?

BALFAXAR patient assistance information can be found through Octapharma. Visit Here →

Where can I find Balfaxar prescribing information?

BALFAXAR prescribing information can be found at the link below: Visit Here →

Where can I find Balfaxar side effect information?

Our team has not yet identified a source of side effect information for BALFAXAR

Does billing BALFAXAR require JZ/JW wastage modifiers?

CMS does not include BALFAXAR (J7165) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J7165. For more information, visit the link below.

About BuyandBill.com:

The BuyandBill.com team is dedicated to delivering high-quality coding and billing information for office-administered drugs. We continuously research HCPCS-coded medications to expand our resources and ensure data accuracy. Manufacturers: click here to sponsor your medication, and we will ensure the most accurate and detailed information is displayed.