Summary & Overview
HCPCS C9468: Recombinant Factor IX (Rebinyn) Injection
HCPCS Level II code C9468 denotes an injection of recombinant, glycopegylated factor IX (Rebinyn) billed per 1 international unit. This code is used to capture administration of a long-acting antihemophilic factor for patients with hemophilia B and is relevant for hospital outpatient departments, infusion centers, and physician office settings. Nationally, accurate coding for specialty biologics like Rebinyn affects coverage decisions, billing consistency, and cost management for high-cost hemophilia therapies.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing overview of the product and its common service settings, plus national benchmarking and policy context where available. The publication covers reimbursement benchmarks and payer coverage patterns, coding guidance essentials, and clinical context explaining when recombinant factor IX therapy is indicated. It also highlights areas where policy updates or payer guidance commonly influence coding and claims processing for high-cost coagulation factor products.
Data not available in the input for specific modifiers, associated taxonomies, ICD-10 diagnoses, related procedure codes, and granular payer-specific coverage policies.
Billing Code Overview
HCPCS Level II code C9468 represents an injection of factor IX (antihemophilic factor, recombinant), glycopegylated, Rebinyn, billed per 1 international unit (i.u.). This code covers administration of a recombinant, glycopegylated coagulation factor IX product used to treat and prevent bleeding in individuals with hemophilia B.
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Service type: Injectable biologic therapy (recombinant factor IX replacement)
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Typical site of service: Infusion clinic, hospital outpatient department, or physician office for outpatient infusion therapy
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Clinical & Coding Specifications
Clinical Context
A 28-year-old male with moderate hemophilia B presents to the hematology infusion clinic for scheduled replacement therapy following a spontaneous knee hemarthrosis. The patient has a history of factor IX deficiency treated with recombinant glycopegylated factor IX (Rebinyn). The clinic verifies weight-based dosing, reviews recent bleeding events and inhibitor testing, obtains informed consent, and prepares the appropriate vial count of C9468 (injection, factor IX (antihemophilic factor, recombinant), glycopegylated, Rebinyn, 1 i.u.). A registered nurse performs IV access, administers the reconstituted product according to manufacturer and institutional infusion protocols, monitors vital signs and for hypersensitivity or infusion-related reactions during and for at least 30 minutes post-infusion, documents lot number and units infused, and updates the electronic medical record and billing with the C9468 HCPCS line item.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting separately identifiable physician services associated with the infusion that are billed independently from the drug administration. |