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See a sample rate comparisonHCPCS J7195 (Benefix) Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Injection, factor IX (antihemophilic factor, recombinant) per IU, not otherwise specified
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Clotting Factors |
| Common Place of Service | None 99 - Other POS |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J7195 |
| Medicare Payment Limit | $1.849  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J7195 by major payers:
$2.06
$2.07
$1.98
$1.95
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HCPCS J7195
5 of 25 sample ratesHigher to lower in this preview
Muhammad Motiwala
Kelsey-Seybold Medical Group PLLC
$4.51Published rateRichard Looney
Pediatric Immunnephrrheumology
$1.95Published rateSameh Abdelaal
$1.84Published ratePeter Yu
Midstate Medical Center
$1.84Published rateRuth White
New York City Health And Hospitals Corporation
$1.44Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J7195 vs. Other Clotting Factors Codes
The HCPCS J7195 code is part of the Drugs Administered Other than Oral Method services used for Clotting Factors. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS J7195 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| J7194-HCPCS | Low | Factor IX, complex, per IU |
| J7195-HCPCS | Low | Injection, factor IX (antihemophilic factor, recombinant) per IU, not otherwise specified |
| J7196-HCPCS | Low | Injection, antithrombin recombinant, 50 IU |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J7195. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J7195 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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