HCPCS
J9034
1 mg = 1 unit
Phase 1
Identify what you're billing
Three bendamustine HCPCS codes exist. Pick the right one before billing.
About Bendeka FDA verified Apr 2026
Teva's premixed, fast-infusion bendamustine HCl — the speed advantage in a crowded bendamustine class.
Bendeka is bendamustine hydrochloride, a hybrid alkylating agent / purine analog used in chronic lymphocytic leukemia (CLL) and indolent B-cell non-Hodgkin lymphoma (iNHL), and as the backbone of the bendamustine + rituximab (BR) combo regimen for first-line iNHL and mantle cell lymphoma. Originally developed by Cephalon (later Teva) and commercialized as a faster-infusion premixed alternative to the original lyophilized Treanda formulation, Bendeka was launched after Eagle Pharmaceuticals' partnership with Teva. Teva now markets the product directly.
The signature clinical-billing distinction: Bendeka infuses over 10 minutes, vs Treanda's 30–60 minutes. That difference dropped chair time by 75%+ when Bendeka launched and became a major contracting wedge in the bendamustine market. Today the bendamustine class includes three branded HCPCS codes (J9034 Bendeka, J9033 Treanda, J9036 Belrapzo) plus generic bendamustine billed under the J9033 Treanda code. Each carries its own ASP, NDC, and payer policy.
BR combo partner cross-reference: Bendamustine + rituximab (BR) is the dominant
first-line regimen for iNHL and a major option for MCL. See our Rituxan
(J9312) billing reference for rituximab-side coding when running BR.
Bendamustine formulation comparison — Bendeka vs Treanda vs Belrapzo CMS verified Apr 2026
All bendamustine HCl. Different J-codes. Different infusion times. Different ASPs.
| Bendeka | Treanda | Belrapzo | |
|---|---|---|---|
| HCPCS | J9034 | J9033 | J9036 |
| HCPCS descriptor | "Inj., bendeka 1 mg" | "Injection, bendamustine HCl, 1 mg" | "Inj., belrapzo, 1 mg" |
| Brand owner | Teva (formerly Eagle/Cephalon) | Teva (originator); generic competition | Eagle Pharmaceuticals |
| Formulation | Premixed solution (25 mg/mL) | Lyophilized powder (requires reconstitution) | Premixed solution (25 mg/mL) |
| Infusion time | 10 minutes (fastest in class) | 30–60 minutes | 10 minutes (similar to Bendeka) |
| Vial sizes | 100 mg / 4 mL · 200 mg / 8 mL | 25 mg · 100 mg lyophilized | 100 mg / 4 mL · 200 mg / 8 mL |
| Reconstitution | None — ready to dilute | Required (sterile water) | None — ready to dilute |
| Q2 2026 ASP+6% | $12.901 / mg (this drug) | Generic-driven, materially lower | Verify CMS Q2 2026 file |
| Indications | CLL, iNHL (post-rituximab), MCL combo | CLL, iNHL (post-rituximab) | CLL, iNHL (post-rituximab) |
| NCCN equivalence | Therapeutically equivalent | Therapeutically equivalent | Therapeutically equivalent |
Do not interchange J-codes. Each formulation carries its own NDC and HCPCS. Submitting
J9034 with a Treanda NDC (or vice versa) triggers an automatic edit denial. The drug administered
determines the J-code — not what the practice prefers to bill.
Why payers care which one you used: Generic bendamustine billed under J9033 typically
reimburses ~50% below Bendeka (J9034). Many UM programs require generic-first step therapy unless
chair-time, infusion-reaction history, or contracting reasons justify the premixed branded products.
Multi-indication dosing matrix FDA label Apr 2026
From FDA prescribing information. Doses are BSA-based; partial-vial waste is the rule.
| Indication | Dose | Schedule | Cycles | Combo |
|---|---|---|---|---|
| CLL (1L or relapsed) | 100 mg/m² | Days 1 + 2 of 28-day cycle | Up to 6 | Monotherapy |
| Indolent B-cell NHL (post-rituximab failure) | 120 mg/m² | Days 1 + 2 of 21-day cycle | Up to 8 | Monotherapy |
| BR — 1L iNHL (NCCN-supported) | 90 mg/m² bendamustine | Days 1 + 2 + Rituxan Day 1, 28-day cycle | 6 | + rituximab |
| BR — MCL (NCCN-supported) | 90 mg/m² bendamustine | Days 1 + 2, 28-day cycle (often + R Day 1) | 6 | + rituximab ± other agents |
Worked example — CLL 100 mg/m² for a 1.7 m² patient
# Per-dose calculation (Days 1 + 2 of each 28-day cycle)
Dose: 100 mg/m² × 1.7 m² = 170 mg per infusion
Vial usage: one 200 mg/8 mL vial — administer 170 mg, discard 30 mg
# Billing per infusion
Drug units billed (administered): J9034 × 170 units with JW modifier line for waste
Wasted units billed: J9034 × 30 units (JW modifier)
Admin: 96413 (10-min chemo IV)
# Year-1 totals (6 cycles × 2 days)
Total infusions: 12
Total drug units billed (administered): 2,040 (12 × 170)
Total drug units billed (waste): 360 (12 × 30)
Total drug cost (Q2 2026 ASP+6%): ~$30,962 (2,400 units × $12.901)
Dose: 100 mg/m² × 1.7 m² = 170 mg per infusion
Vial usage: one 200 mg/8 mL vial — administer 170 mg, discard 30 mg
# Billing per infusion
Drug units billed (administered): J9034 × 170 units with JW modifier line for waste
Wasted units billed: J9034 × 30 units (JW modifier)
Admin: 96413 (10-min chemo IV)
# Year-1 totals (6 cycles × 2 days)
Total infusions: 12
Total drug units billed (administered): 2,040 (12 × 170)
Total drug units billed (waste): 360 (12 × 30)
Total drug cost (Q2 2026 ASP+6%): ~$30,962 (2,400 units × $12.901)
Worked example — iNHL 120 mg/m² for a 1.8 m² patient
# Per-dose calculation (Days 1 + 2 of each 21-day cycle)
Dose: 120 mg/m² × 1.8 m² = 216 mg per infusion
Vial usage: one 200 mg/8 mL vial + one 100 mg/4 mL vial — administer 216 mg, discard 84 mg
# Billing per infusion
Drug units billed (administered): J9034 × 216 units
Wasted units billed: J9034 × 84 units (JW modifier)
# Year-1 totals (8 cycles × 2 days)
Total infusions: 16
Total drug units billed (administered): 3,456
Total drug units billed (waste): 1,344
Total drug cost (Q2 2026 ASP+6%): ~$61,925 (4,800 units × $12.901)
Dose: 120 mg/m² × 1.8 m² = 216 mg per infusion
Vial usage: one 200 mg/8 mL vial + one 100 mg/4 mL vial — administer 216 mg, discard 84 mg
# Billing per infusion
Drug units billed (administered): J9034 × 216 units
Wasted units billed: J9034 × 84 units (JW modifier)
# Year-1 totals (8 cycles × 2 days)
Total infusions: 16
Total drug units billed (administered): 3,456
Total drug units billed (waste): 1,344
Total drug cost (Q2 2026 ASP+6%): ~$61,925 (4,800 units × $12.901)
BSA dosing into fixed vial sizes = waste on most claims. The 100 mg and 200 mg vial
sizes rarely line up cleanly with a BSA-based dose. Compute waste explicitly and bill it under JW on
a separate claim line. Failure to bill waste leaves money on the table; failure to document the JW
line with actual discarded units is a common audit trigger.
Premedication protocol FDA label verified Apr 2026
Required pre-infusion regimen to mitigate infusion reactions and tumor lysis syndrome risk.
Pre-infusion (every dose)
- Antihistamine — e.g., diphenhydramine 25–50 mg PO/IV (CPT 96365 + J1200 if IV; not bundled into J9034)
- Antipyretic — e.g., acetaminophen 650–1,000 mg PO
- Corticosteroid — e.g., dexamethasone 4–8 mg IV (J1100); particularly important if prior infusion reaction history
Tumor lysis syndrome (TLS) prophylaxis
- Allopurinol 300 mg PO daily for the first 1–2 cycles, especially in patients with high tumor burden (CLL with WBC > 50,000, bulky lymphoma)
- Consider rasburicase for very high-risk patients
- Maintain hydration before, during, and after infusion
Opportunistic infection prophylaxis
- Bendamustine causes profound and prolonged lymphopenia. Consider PCP (Pneumocystis jirovecii) prophylaxis with TMP/SMX during therapy and for several months after
- Screen for HBV (HBsAg, anti-HBc) before initiating — reactivation is a known risk; treat or co-administer antiviral prophylaxis (entecavir or tenofovir) if HBV-positive
- Monitor for CMV reactivation in heavily pretreated patients
Severe skin reactions reported. SJS/TEN/DRESS have been reported, particularly when
bendamustine is combined with allopurinol (counterintuitively, given allopurinol is also used for TLS
prophylaxis). Monitor for rash and discontinue both if severe skin reaction develops.
Premeds bill separately under their own J-codes/CPT — nothing is bundled into J9034. Document
every premed administered for accurate billing and audit defense.
NDC reference FDA NDC Directory verified May 2026
| NDC (10/11-digit) | Package | Use |
|---|---|---|
42367-521-25 / 42367-0521-25 |
100 mg / 4 mL premixed single-dose vial — 1 vial per carton | Doses < 100 mg (with waste); top-up for BSA-based dose > 200 mg |
42367-531-26 / 42367-0531-26 |
200 mg / 8 mL premixed single-dose vial — 1 vial per carton | Most adult doses (CLL/iNHL/BR all in 90–220 mg range typically) |
Use the carton-level NDC on the claim form (Box 24A shaded). Pair with
ML
unit-of-measure qualifier and total mL administered (4 mL per 100 mg vial, 8 mL per 200 mg vial).
Most BSA-based doses combine vials — sum the volumes accordingly.
NDCs verify against the FDA NDC Directory. Confirm current Teva NDCs at billing time;
Teva has periodically refreshed labeling.
Phase 2
Code the claim
Chemo admin codes apply. Vial waste accounting is the most common error.
Administration codes CPT verified May 2026
Bendamustine is a true cytotoxic alkylating agent — chemo admin codes apply.
| Code | Description | When to use |
|---|---|---|
96413 |
Chemotherapy administration, IV infusion technique; up to 1 hour, single or initial substance/drug | Primary code for Bendeka. 10-min infusion fits cleanly within the 1-hour window. |
96415 |
Chemotherapy administration, IV infusion; each additional hour | Typically NOT needed for Bendeka monotherapy. Bendeka's 10-min infusion does not extend beyond the 96413 window. |
96417 |
Chemotherapy administration, IV infusion; each additional sequential infusion (different substance) | Use on BR combo days for the additional rituximab infusion sequenced after bendamustine. |
96365 / 96366 |
Therapeutic IV infusion (non-chemo) | NOT appropriate for Bendeka. Bendamustine is cytotoxic chemo. 96413 pays materially more. |
BR combo day — sequencing matters. On Day 1 of a BR cycle, both bendamustine and
rituximab infuse. Conventional sequencing: rituximab first (longer infusion + higher infusion-reaction
risk), then bendamustine. Bill 96413 once for the initial chemo admin (the first chemo drug on the encounter)
and 96417 for the additional sequential infusion. Verify hierarchy rules with your MAC's chemo admin
coding guidance.
Modifiers (JZ + JW) CMS verified May 2026
JW — nearly always applies on Bendeka claims
Effective July 1, 2023, CMS requires JW or JZ on every single-dose container claim. Bendeka comes in 100 mg and 200 mg fixed vial sizes; doses are BSA-based. Partial-vial waste is the rule rather than the exception — almost every Bendeka dose results in some discarded drug. Bill the discarded amount on a separate claim line with the JW modifier.
JZ — only when waste is genuinely zero
JZ applies when no drug is discarded. This is rare for Bendeka but possible when the BSA-calculated dose happens to equal a clean 100 mg or 200 mg multiple (e.g., a 2.0 m² patient on the BR 90 mg/m² regimen receives 180 mg, fitting cleanly within one 200 mg vial — still 20 mg waste). Verify the math before defaulting to JZ.
The most common Bendeka billing error: missing JW for waste. CMS audits often catch
this. Compute waste explicitly: vial mg used − mg administered = waste mg = JW units. Bill JW
with the actual discarded units alongside the JZ-style admin line for the units administered. Wasted
drug from a single-dose vial is reimbursable but must be reported.
Modifier 25 — same-day E/M
Use modifier 25 on the E/M code when a significant, separately identifiable evaluation and management service is performed on the same day as the infusion. Routine pre-infusion clinical assessment is bundled into 96413.
340B modifiers (JG, TB)
For 340B-acquired Bendeka, follow your MAC's current 340B modifier policy. Teva's billing guide does not provide 340B-specific instructions.
ICD-10-CM by indication FY2026 verified May 2026
Use the most specific code supported by encounter documentation. Pathology required.
| Indication | ICD-10 | Notes |
|---|---|---|
| CLL, not having achieved remission | C91.10 | Most common 1L CLL bill |
| CLL, in remission | C91.11 | Use when documentation supports remission |
| CLL, in relapse | C91.12 | Most common 2L+ bill; supports relapsed-refractory PA criteria |
| Follicular lymphoma (most common iNHL) | C82.0–C82.7, C82.9 | 4th character = grade; 5th = site |
| Marginal zone lymphoma (iNHL subtype) | C83.0x | Splenic/nodal/extranodal MZL |
| Other / unspecified non-follicular B-cell lymphoma | C83.8x, C83.9x | iNHL post-rituximab failure indication |
| Mantle cell lymphoma (MCL) | C83.1x | BR combo regimen |
| Lymphoplasmacytic lymphoma (LPL/Waldenström) | C88.0 | Off-label but NCCN-supported in some scenarios |
| Small lymphocytic lymphoma (SLL, CLL variant) | C83.0x | Treat as CLL for bendamustine billing |
iNHL indication requires documented prior rituximab failure. The 120 mg/m²
21-day cycle iNHL indication is specifically for B-cell NHL that progressed during or within six months
of rituximab or a rituximab-containing regimen. PA submissions must include prior therapy documentation.
Site of care & place of service Verified May 2026
Commercial payers run site-of-care UM for high-cost specialty oncology infusions. The 10-minute Bendeka infusion is operationally suited to office and AIC settings — HOPD administration is increasingly disfavored after the first cycle on commercial plans.
| Setting | POS | Claim form | Payer steering |
|---|---|---|---|
| Physician oncology office | 11 | CMS-1500 / 837P | Preferred by commercial UM |
| Ambulatory infusion suite (AIC) | 49 | CMS-1500 / 837P | Preferred by commercial UM |
| Oncology ASC | 24 | CMS-1500 / 837P | Acceptable |
| Hospital outpatient (on-campus) | 22 | UB-04 / 837I | Disfavored after first cycle on commercial |
| Hospital outpatient (off-campus PBD) | 19 | UB-04 / 837I | Disfavored after first cycle on commercial |
| Patient home | 12 | CMS-1500 (with home infusion) | Possible but rare for cytotoxic chemo |
Bendeka's 10-min infusion = office advantage. Among bendamustine formulations, Bendeka's
short chair time makes office-based administration uniquely operational. This aligns with payer
site-of-care steering.
Claim form field mapping Verified May 2026
CMS-1500 / 837P fields for office, AIC, and ASC. Hospital outpatient uses UB-04 with REV codes.
| Information | CMS-1500 box | Notes |
|---|---|---|
| NPI | 17b | Rendering provider |
| NDC qualifier + 11-digit NDC + UoM + qty | 24A shaded area | N4 + carton NDC + ML + total volume (4 mL per 100 mg vial, 8 mL per 200 mg vial) |
| HCPCS J9034 + JZ or JW (administered units) | 24D (drug line) | Mark JZ if zero waste; JW with discarded units if any waste |
| HCPCS J9034 + JW (waste line, separate) | 24D (waste line) | Discarded units only; required when partial vial waste |
| Drug units (administered) | 24G | Actual mg administered |
| Drug units (waste, on JW line) | 24G | Discarded mg from single-dose vial |
| CPT 96413 (admin line) | 24D | 10-min infusion fits within 1-hour window |
| CPT 96417 (BR combo days) | 24D | For sequential rituximab infusion on Day 1 of BR cycle |
| ICD-10 | 21 | Indication-specific (CLL/iNHL/MCL family) |
| PA number | 23 | Required by all major commercial payers |
Phase 3
Get paid
PA always required. Generic-vs-branded steering is the major denial risk.
Payer policy snapshot Reviewed May 2026
All major commercial payers require PA for J9034. UHC oncology policies steer to generic when clinically appropriate.
| Payer | PA? | Step / preference | Site-of-care UM |
|---|---|---|---|
| UnitedHealthcare Oncology Med Coverage Policy |
Yes | Pathology required (CLL/iNHL/MCL); prior therapy docs for iNHL post-rituximab indication. May prefer generic bendamustine (J9033) — document why Bendeka. | Yes — ICI-style steering away from HOPD via Optum-managed program |
| Aetna CPB + Medical Drug policies |
Yes | Pathology required; iNHL requires documented prior rituximab failure | Yes — separate site-of-care policy disfavors HOPD after first cycle |
| BCBS plans Vary by plan |
Yes | Generally aligned with NCCN guidelines; pathology + prior therapy documentation | Plan-specific; most have site-of-care steering |
| Carelon / Anthem Specialty oncology UM |
Yes | NCCN-aligned pathology + line-of-therapy documentation | Yes |
Step therapy
Step therapy through generic bendamustine (J9033) is the dominant commercial payer practice. Some plans accept Bendeka without step if clinical justification (prior generic intolerance, infusion-reaction history, infusion-chair-time constraints, contracting reasons) is documented in the PA submission. NCCN guidelines treat all bendamustine formulations as therapeutically equivalent.
Medicare reimbursement CMS Q2 2026 (live)
Quarterly ASP from CMS Part B Drug Pricing File. Refreshes automatically each quarter.
Q2 2026 payment snapshot — J9034
Effective April 1 – June 30, 2026 · Based on 4Q25 ASP submissions
ASP + 6%
$12.901
per mg / per unit
100 mg dose
$1,290.10
100 units × ASP+6%
200 mg dose
$2,580.20
200 units × ASP+6%
Annualized cost examples (Medicare ASP+6%, before sequestration):
CLL 100 mg/m² for 1.7 m² patient × 12 infusions (6 cycles × 2 days) including waste ≈ ~$30,962.
iNHL 120 mg/m² for 1.8 m² patient × 16 infusions (8 cycles × 2 days) including waste ≈ ~$61,925.
After ~2% sequestration: ~95.7% of these totals actually paid.
Coverage
No NCD specific to bendamustine. Coverage falls under MAC LCDs for chemotherapy + the generic drug-coverage framework. All MACs cover J9034 for FDA-approved on-label CLL and iNHL indications, with appropriate ICD-10 and pathology documentation. MCL combo regimens are covered when NCCN-supported.
Bendamustine class pricing context
- J9034 Bendeka — $12.901/mg (Q2 2026)
- J9033 Treanda + generics — materially lower; verify current CMS Q2 2026 file
- J9036 Belrapzo — verify current CMS Q2 2026 file (similar premixed product to Bendeka)
Patient assistance — Teva Shared Solutions Teva verified May 2026
- Teva Shared Solutions: 1-888-825-1356 — benefits investigation, prior authorization assistance, appeal support, copay program enrollment
- Bendeka Co-pay Assistance Program: commercial copay support; eligible commercially-insured patients (excludes Medicare, Medicaid, federal program patients)
- Teva Patient Assistance Program: free product for uninsured / underinsured patients meeting income requirements
- Foundations: for Medicare patients, refer to PAN, HealthWell, CancerCare, Leukemia & Lymphoma Society Co-Pay Assistance Program — verify open CLL/NHL funds quarterly
- Web: bendeka.com · Teva Shared Solutions: tevasharedsolutions.com
Need to model what a specific patient will actually pay after copay assistance, deductible, coinsurance,
and OOP max? Run a CareCost Estimate — J9034 pre-loaded.
Phase 4
Fix problems
JW waste accounting, generic-vs-branded steering, and BR combo sequencing are the top three.
Common denials & how to fix them
| Denial reason | Common cause | Fix |
|---|---|---|
| Missing JW waste line | BSA dose with partial-vial waste billed without JW line for discarded units | Resubmit with separate JW line documenting the discarded mg. Compute: vial mg used − mg administered = JW units. |
| Step therapy through generic bendamustine | UHC/commercial PA denied because patient hasn't tried generic bendamustine (J9033) | Document prior generic trial / intolerance / infusion-reaction history, or attest to chair-time-driven need for premixed 10-min product. Reference NCCN equivalence. |
| Wrong J-code (J9033 vs J9034 vs J9036) | NDC/J-code mismatch — billed J9033 with Bendeka NDC or vice versa | Match the J-code to the actual product administered. Bendeka NDCs always pair with J9034. |
| Wrong admin code (96365) | Therapeutic IV billed instead of chemo IV | Resubmit with 96413. Bendamustine is cytotoxic chemo per CPT classification. |
| BR combo billed as monotherapy | Day 1 of BR cycle billed without 96417 sequential infusion line | Add 96417 for the additional sequential infusion (rituximab after bendamustine, or vice versa per institutional sequencing). |
| iNHL indication without prior rituximab documentation | 120 mg/m² iNHL bill submitted without prior rituximab failure history in PA | Resubmit PA with documented prior rituximab regimen, dates, response, and progression within 6 months. |
| Pathology not in PA | CLL/iNHL/MCL bill without pathology report attached | Resubmit PA with pathology report, flow cytometry, and (for MCL) cyclin D1 / t(11;14) confirmation. |
| Site of care (HOPD) | HOPD administration after first cycle on commercial plan with site-of-care UM | Move to office (POS 11) or AIC (POS 49). Submit medical necessity letter if HOPD required. |
| JZ on partial-vial-waste claim | JZ used when waste actually existed | Replace with JW line for discarded units. JZ only valid when zero waste. |
Frequently asked questions
What is the HCPCS code for Bendeka?
Bendeka (bendamustine HCl IV, Teva premixed) is billed under HCPCS J9034 —
"Injection, bendeka, 1 mg." Each milligram equals one billable unit. Bendeka is distinct from Treanda
(J9033, original lyophilized bendamustine) and Belrapzo (J9036, Eagle's other
premixed bendamustine).
How is Bendeka different from Treanda and Belrapzo?
All three are bendamustine HCl but bill under different J-codes with different infusion characteristics. Bendeka (J9034, Teva premixed) infuses over 10 minutes — the fastest in class. Treanda (J9033, originator lyophilized) requires reconstitution and infuses over 30–60 minutes; generic bendamustine bills under J9033. Belrapzo (J9036, Eagle premixed) is also a fast-infusion premixed product. UHC and other payers may steer to generic J9033 for cost reasons (typically ~50% cheaper) when clinically appropriate. See the formulation comparison.
What is the dosing for Bendeka in CLL?
FDA-labeled CLL dose: 100 mg/m² IV over 10 minutes on Days 1 and 2 of each 28-day cycle, for up to 6 cycles. Bill the actual mg administered as J9034 units (e.g., 1.7 m² patient → 170 mg / 170 units per dose).
What is the dosing for Bendeka in indolent B-cell NHL?
FDA-labeled iNHL dose (post-rituximab failure): 120 mg/m² IV over 10 minutes on Days 1 and 2 of each 21-day cycle, for up to 8 cycles. The bendamustine + rituximab (BR) combo regimen for first-line iNHL uses a lower 90 mg/m² dose on Days 1 + 2 of a 28-day cycle for 6 cycles.
Do I bill JZ or JW for Bendeka?
Both can apply, but JW is the more common case for Bendeka. Bendeka comes in 100 mg and 200 mg fixed vial sizes; BSA-based dosing means partial-vial waste on most claims. Bill JZ only when no drug is discarded (rare); bill JW with the discarded units on a separate claim line whenever any portion of a single-dose vial is discarded. One of JZ or JW must appear on every J9034 claim.
What administration CPT do I use for Bendeka?
CPT 96413 — "Chemotherapy administration, IV infusion technique; up to 1 hour, single
or initial substance/drug." Bendeka's signature 10-minute infusion fits cleanly inside the 96413
1-hour window. For BR combo days, sequence the additional rituximab infusion under 96417. Do NOT
bill 96365.
What is the Medicare reimbursement for J9034?
For Q2 2026, the Medicare Part B payment limit for J9034 is $12.901 per mg (ASP + 6%). A 1.7 m² CLL patient at 100 mg/m² (170 mg) reimburses at approximately $2,193.17 per infusion (drug only, before waste accounting). Sequestration (~2%) reduces actual paid to roughly ASP + 4.3%.
Is premedication required for Bendeka?
Yes — per FDA label. Standard regimen: antihistamine + antipyretic + corticosteroid before each infusion to mitigate the ~14% risk of infusion reactions. Allopurinol for the first 1–2 cycles in patients with high tumor burden (CLL with WBC > 50,000) to prevent tumor lysis syndrome. PCP prophylaxis with TMP/SMX should be considered. Premeds bill separately under their own J-codes/CPT.
Will UHC prefer generic bendamustine over Bendeka?
Often, yes. UHC and other commercial payers may apply step therapy or non-preferred status to Bendeka (J9034) and steer to generic bendamustine billed under J9033, which typically reimburses ~50% lower. Trade-off: generic J9033 requires reconstitution and 30–60 min infusion vs Bendeka's premixed 10-min infusion. Document prior generic trial/intolerance, infusion-chair-time constraints, or prior approved authorization in the PA submission. NCCN guidelines treat all bendamustine formulations as therapeutically equivalent.
Reference
Sources & methodology
Every claim on this page is sourced. Methodology and review history below.
Source documents
- DailyMed — BENDEKA (bendamustine hydrochloride) Prescribing Information
- FDA Bendeka label PDF (most recent revision)
- Bendeka.com — Teva HCP product site
- Teva Shared Solutions — patient access support
- CMS — Medicare Part B Drug ASP Pricing File
- SEER CanMED — HCPCS J9034 reference
- SEER CanMED — HCPCS J9033 (Treanda + generic bendamustine) reference
- SEER CanMED — HCPCS J9036 (Belrapzo) reference
- UnitedHealthcare — Oncology Medication Clinical Coverage Policy
- Aetna Clinical Policy Bulletins (search "bendamustine")
- NCCN Clinical Practice Guidelines — CLL/SLL, B-cell Lymphomas, MCL
- FDA National Drug Code Directory
About this page
We maintain this page as a living reference. Medicare ASP pricing is bound to our underlying CareCost data layer and refreshes automatically when CMS publishes new quarterly files. Coding and policy content is reviewed at least quarterly and updated whenever a source document changes.
Found an error? Email hello@carecostestimate.com.
Refresh cadence
| Element | Cadence | How it's refreshed |
|---|---|---|
| Medicare ASP pricing | Quarterly | Auto-bound to CareCost ASP layer; updates on CMS file release. |
| Payer policies (UHC, Aetna, Carelon, BCBS) | Semi-annual | Manual review against published payer policy documents. |
| HCPCS / CPT / modifier rules | Annual | Reviewed against CMS HCPCS quarterly files and AMA CPT releases. |
| NDC, dosing, FDA label, formulation comparison | Event-driven | Tied to manufacturer document version + FDA label revision date + new bendamustine entrants. |
Reviewer
Pending SME review. This page is staff-authored from primary sources (FDA, CMS, Teva,
payer documents — all linked above). Editorial review in progress.
Until that review is complete, treat this as a draft reference and verify each cited source for
high-stakes claims.
Change log
- — Initial publication. ASP data: Q2 2026 ($12.901/mg). Manufacturer source: Teva 2026. FDA label verified Apr 2026. Three-formulation bendamustine comparison (J9033 / J9034 / J9036). BR combo regimen with cross-link to Rituxan (J9312).
Methodology
Every claim on this page is sourced inline. Pricing reflects the current CMS Part B Drug ASP Pricing File. Payer policies are read directly from each payer's published medical/pharmacy policy documents. Indication list and dosing schedules are verified against the current FDA label revision. We do not paraphrase from billing-software vendor blogs.