Quick answer
J9034
What Medicare pays for Bendeka (2026 Q4)
2026 Q4 payment limit per billing unit for Bendeka’s HCPCS code (how ASP + 6% works):
| HCPCS | Description | Per unit | Allowed (ASP + 6%) |
|---|---|---|---|
| J9034 | Inj., bendeka 1 mg | 1 mg | $11.422 |
CMS ASP Drug Pricing File, 2026 Q4. Bendeka patient out-of-pocket estimate →
Worked billing example for Bendeka
A concrete, paste-checkable example using J9034’s own billing-unit basis and vial sizes — not a hypothetical.
| Scenario | CLL dose — 100 mg/m² for a 1.7 m² reference patient (170 mg) |
| Dose administered | 170 mg |
| Billing unit basis | 1 unit = 1 mg |
| Billing units (dose ÷ unit basis, rounded up) | 170 units of J9034 |
| Vial combination drawn (min-waste plan) | 2 × 100 mg vials |
| Discarded (waste) | 30 mg |
| Wastage modifier (JW / JZ) | Bill the 170 administered units on one claim line (no wastage modifier), and the 30 discarded units on a separate line with JW. Do not add JZ — JW and JZ are never billed together for the same drug on the same date of service. JW vs JZ, with examples → |
| Medicare allowable (ASP + 6%, 2026 Q4) | 200 units × $11.422/unit = $2284.40 |
Allowable, not paid: sequestration and the covered diagnosis still apply.
Dose source: drugs/bendeka.html — "Worked example — CLL 100 mg/m² for a 1.7 m² patient": 170 mg per infusion. Different dose or drug? Compute your own dose → or estimate the full cost & patient out-of-pocket →.
Bendeka (HCPCS J9034) is paid under Part B only when the claim’s ICD-10 code is one the MAC accepts; otherwise expect a CO-50 denial. How Part B drug coverage is decided →
Covered ICD-10 diagnoses for Bendeka
The 5 FDA-approved indications for J9034, grouped by condition — filter to find a code.
CLL — 1 diagnoses (applies to J9034)
Neoplasms (1)
| ICD-10 | Covered diagnosis |
|---|---|
| C91.10 | Chronic lymphocytic leukemia of B-cell type not having achieved remission |
NHL — 1 diagnoses (applies to J9034)
Neoplasms (1)
| ICD-10 | Covered diagnosis |
|---|---|
| C85.90 | Non-Hodgkin lymphoma, unspecified, unspecified site |
Follicular Lymphoma — 1 diagnoses (applies to J9034)
Neoplasms (1)
| ICD-10 | Covered diagnosis |
|---|---|
| C82.90 | Follicular lymphoma, unspecified, unspecified site |
DLBCL — 1 diagnoses (applies to J9034)
Neoplasms (1)
| ICD-10 | Covered diagnosis |
|---|---|
| C83.30 | Diffuse large B-cell lymphoma, unspecified site |
Encounter — 1 diagnoses (applies to J9034)
Factors influencing health status (1)
| ICD-10 | Covered diagnosis |
|---|---|
| Z51.11 | Encounter for antineoplastic chemotherapy |
How to bill Bendeka
Put a medically necessary, FDA-indicated diagnosis from the list above on the claim line with J9034. Matching codes, units and JZ/JW wastage →
Which policy governs Bendeka
No drug-specific LCD or Article — see the note at the top of this page. Find your MAC → What an LCD, an Article and an NCD each govern →
If a claim for Bendeka is denied
With no drug-specific Article, the usual cause is a diagnosis the MAC does not accept as medically necessary for J9034, or an off-label use with no compendium support. The five denial patterns and how to fix each →
Frequently asked questions
- Is Bendeka covered by Medicare?
- Yes. Bendeka (J9034) is covered under Medicare Part B as a physician-administered drug when billed for a medically necessary indication. There is no drug-specific Local Coverage Determination (LCD) for it, so coverage is determined per medical necessity by your MAC; the FDA-approved indications below are the starting point. None of the 8 Medicare Administrative Contractors lists J9034 as self-administered.
- What diagnoses are covered for Bendeka (J9034)?
- Medicare publishes no drug-specific covered-diagnosis list for J9034. The 5 ICD-10 codes here are the FDA-approved indications; an off-label use needs approved-compendium support (DrugDex, NCCN) to be payable.
- Which Medicare policy covers Bendeka?
- No drug-specific LCD or Billing & Coding Article exists for Bendeka. It's covered under the general Medicare Part B drug benefit per medical necessity, as judged by your Medicare Administrative Contractor (MAC).
- Why was my Bendeka claim denied as not medically necessary?
- The most common cause is a diagnosis the MAC doesn't consider medically necessary for J9034. Bill a covered/FDA-approved indication from the list below, document medical necessity, and confirm any local guidance with your MAC.
Related references
Covered is only half the answer.
You know the diagnosis is payable. Now quote the patient before the visit and catch underpayments: get Bendeka's exact Medicare allowed amount, your payer's rate vs. ASP+6%, and the patient's out-of-pocket — in about 30 seconds, free.
Estimate Bendeka cost & patient owe →Source & verification
- Source
- FDA-approved indications (Drugs@FDA labeling) mapped to ICD-10-CM. No drug-specific Medicare LCD/Article exists for Bendeka — Part B coverage is determined per medical necessity by your MAC.
- Primary sources
- DailyMed — Bendeka prescribing information · CMS Part B Drug ASP Pricing File — the quarterly payment limit quoted above · CMS Medicare Coverage Database — searched for “Bendeka”; no drug-specific NCD, LCD or Billing & Coding Article exists, which is why the FDA-indicated codes above are the working list
- Page last reviewed by CareCost
- Aug 23, 2026 (coverage data retrieved 2026-09-21; we re-verify against CMS quarterly).
- Notes
- ICD-10-CM is public domain; CPT® (AMA) is intentionally not listed. Reference, not billing advice — built from the CMS Coverage API per our methodology; corrections to editorial@carecostestimate.com.