Home Drug Codes J Codes J7195 · BENEFIX
Updated July 1st, 2026

BENEFIX J Code: J7195

Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified

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Q4 2026 Medicare Payment Limit for J7195, effective October 1, 2026: $1.868 per HCPCS billing unit, up 0.2% from $1.864. From CMS's final file.

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Medicare Payment Limit ?
$1.864
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$1.864
/ HCPCS billing unit · APC 0932
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
5
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Drug & Product Overview

HCPCS Descriptor Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified
HCPCS Added Date January 1, 2002
Manufacturer Pfizer
Route of Administration Intravenous
Generic Status Single-Source; Branded
Dosage Type Single-Dose
Dosage Form Kit

About BENEFIX

Benefix is a medication aligned to the HCPCS J Code: J7195 for billing, pricing, and reimbursement purposes in the United States. It is a Hematology drug administered via the intravenous route and manufactured by Pfizer.

According to CMS Drug Use Information: This medication is used to prevent or control bleeding in people with little or no factor IX (due to hemophilia B, Christmas disease). Factor IX is a protein (clotting factor) in the blood that works with other clotting factors to help the blood clot and stop bleeding. People with little or no factor IX are at risk for bleeding longer after an injury/surgery or bleeding suddenly (often in the joints/muscle) without an obvious cause. This medication should not be used to treat other types of factor deficiencies (such as factors II, VII, VIII, X) or factor problems (such as inhibitor to factor XIII), to reverse the effects of "blood thinners" (such as warfarin), or to treat bleeding from low levels of liver-dependent clotting factors (due to liver problems).

Disclaimer: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your healthcare professional.

NDC Code Information

Based on publicly available CMS files. The list of NDCs below is not exhaustive.

NDC Code Drug Manufacturer Billing Units / Pkg Package Size
58394-0633-03 BeneFIX Wyeth BioPharma Division of Wyeth Pharmaceuticals LLC 1 Kit
58394-0634-03 BeneFIX Wyeth BioPharma Division of Wyeth Pharmaceuticals LLC 1 Kit
58394-0635-03 BeneFIX Wyeth BioPharma Division of Wyeth Pharmaceuticals LLC 1 Kit
58394-0636-03 BeneFIX Wyeth BioPharma Division of Wyeth Pharmaceuticals LLC 1 Kit
58394-0637-03 BeneFIX Wyeth BioPharma Division of Wyeth Pharmaceuticals LLC 1 Kit
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BENEFIX Pricing & Reimbursement

J7195 Private Payer Reimbursement
$1.64 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna

Historical Graphing and Billing Calculator

per HCPCS unit
As of Q3 2026

BENEFIX CPT Administration Codes

The below list of CPT codes is intended for informational purposes only and may not be exhaustive. CPT® codes and descriptions are copyright American Medical Association (AMA). All rights reserved.

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

CMS does not include Benefix (J7195) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J7195. Wastage billing guide →

BENEFIX Medically Unlikely Edits (MUE)

The most billing units of J7195 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 iu. The limit is different in the office and the hospital. Use the one for your setting.

Practitioner Office
6,000 units / day
= 6,000 iu per day
Hospital Outpatient
20,000 units / day
= 20,000 iu per day

MAI 1 · Line Edit. Per-line limit: units are checked per claim line; medically necessary units beyond the limit may be billable on separate lines with appropriate modifiers. See all MUE limits →

iu Enter a dose to see how many billing units it is and whether it is under the limit.

BENEFIX 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.

Hemophilia B (congenital factor IX deficiency or Christmas disease)

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Frequently Asked Questions

Is there an available Benefix billing and coding guide?
Our team has not identified a manufacturer-published source of billing and coding information for BENEFIX.
Are there any available Benefix patient assistance programs?
BENEFIX patient assistance information can be found through Pfizer. Visit Here →
Where can I find Benefix prescribing information?
BENEFIX prescribing information can be found at the link below: Visit Here →
Where can I find Benefix side effect information?
Information regarding BENEFIX's side effects can be found at MedlinePlus Visit Here →
Does billing BENEFIX require JZ/JW wastage modifiers?
CMS does not include BENEFIX (J7195) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J7195. For more information, visit the link below.

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