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HCPCS code J2561: Sezaby injection, per 1 mg2026 Medicare rate & RVUs

J2561 identifies Sezaby, an intravenous phenobarbital sodium product used to treat seizures in term and near-term newborns.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · J2561

Sezaby injection, per 1 mg

Office or facility?

Work RVUs
0
Total RVUs
0.00
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for J2561 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What J2561 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What J2561 covers

J2561 identifies Sezaby, a phenobarbital sodium injection used to treat neonatal seizures in term and near-term infants. It is administered intravenously in hospital settings, typically by clinicians caring for newborns, such as neonatologists or other hospital-based providers. Report this code when the Sezaby product is used; the code distinguishes it from other phenobarbital sodium products.

CMS assigns status E, excluding J2561 from the physician fee schedule under regulation. When Medicare covers the drug, payment is under another payment method; CMS classifies it as a Part B drug generally priced from quarterly Average Sales Price files. Coverage is left to the Medicare contractor’s judgment. The billing unit is 1 mg, so one unit represents 1 mg administered.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where J2561 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

J2561 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

J2561 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
J2561 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the J2561 rate is calculated

Each of J2561’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · J2561

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.00

0.00 RVUs× 1.000 GPCI

Practice expense0.00

0.00 RVUs× 1.000 GPCI

Malpractice0.00

0.00 RVUs× 1.000 GPCI

Adjusted RVUs

0.0000

Conversion factor

$33.4009

Medicare rate

$0.00

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for J2561

J2561 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Place of service · J2561

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

—

J2561 isn’t priced in this setting.

J2561 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • J2561

    Sezaby injection, per 1 mg0 wRVU

    Not priced

  • J2560

    Phenobarbital injection, up to 120 mg0 wRVU

    Not priced

  • J2515

    Pentobarbital injection, per 50 mg0 wRVU

    Not priced

  • 96374

    IV push, single or initial IV push0.18 wRVU

    $37.74

How to choose

J2560Phenobarbital injectionUp to 120 mg
J2561 is specific to Sezaby and is measured per 1 mg. J2560 is for another phenobarbital sodium injection product and is measured in units of up to 120 mg.
J2515Pentobarbital injectionPer 50 mg
J2515 identifies pentobarbital sodium, a different drug. J2561 is for phenobarbital sodium in the Sezaby product.
96374IV pushSingle or initial IV push
96374 describes intravenous push administration, not the drug itself. Report J2561 for Sezaby when applicable to the claim.

Codes related to J2561

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to J2561
CodeHow it relatesNational office range
Used instead
J2560Phenobarbital injection, up to 120 mgAnother phenobarbital sodium injection code; use the code matching the product administered.No office rate
Often billed with
96374IV push, single or initial IV pushMay accompany J2561 when the drug is administered by intravenous push.$33.04–$51.82
96365IV drug infusion, initial, first hourMay accompany J2561 when the drug is administered by intravenous infusion.$58.20–$93.27

J2561 billing questions

When should J2561 be used instead of J2560?

Use J2561 for the Sezaby product. J2560 represents another phenobarbital sodium injection code and uses a different unit basis.

How many units should be reported?

Each J2561 unit represents 1 mg of Sezaby administered. For example, 20 mg corresponds to 20 units.

Is J2561 paid under the physician fee schedule?

No. CMS assigns status E, excluding it from the physician fee schedule. When Medicare covers the drug, it is paid under another payment method and is classified as a Part B drug generally priced from quarterly ASP files.

Does Medicare cover J2561 automatically?

No. Medicare coverage is left to the Medicare contractor’s judgment.

Which administration code may accompany J2561?

For intravenous administration, the applicable administration code depends on how the drug is given, such as an IV push or an infusion. J2561 identifies the drug, not its administration.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates

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