HCPCS code J2561: Sezaby injection, per 1 mg2026 Medicare rate & RVUs in Texas
J2561 identifies Sezaby, an intravenous phenobarbital sodium product used to treat seizures in term and near-term newborns.
CMS doesn’t publish an office rate for J2561 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | Unavailable |
| Beaumont, TX | Unavailable | Unavailable |
| Brazoria, TX | Unavailable | Unavailable |
| Dallas, TX | Unavailable | Unavailable |
| Fort Worth, TX | Unavailable | Unavailable |
| Galveston, TX | Unavailable | Unavailable |
| Houston, TX | Unavailable | Unavailable |
| Rest of Texas | Unavailable | Unavailable |
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
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
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.
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
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