J0561 HCPCS code: Injection, penicillin g benzathine, 100,000 units
J0561 is the HCPCS Level II code for injection, penicillin g benzathine, 100,000 units. In 2024 Medicare paid an average of $16.61 per service for J0561 across 45,214 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 24 per day on outpatient hospital claims. Medicare volume fell 34% from 2022 to 2024 (68,087 to 45,214 services). In 2024, about 1,218 clinicians billed Medicare for J0561 for 1,484 beneficiaries; Texas, California, Louisiana accounted for 32% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2011-01-01 |
| Last action effective | 2016-01-01 |
Who bills J0561 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,218 |
| Medicare beneficiaries | 1,484 |
| States with claims | 35 |
| Share of services in top 3 states (Texas, California, Louisiana) | 32% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0561, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 68,087 | 2,576 | $14.42 | $10.88 |
| 2023 | 61,551 | 2,255 | $17.37 | $13.40 |
| 2024 | 45,214 | 1,484 | $20.49 | $16.61 |
States with the most J0561 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 6,237 | $17.17 |
| California | 4,617 | $17.21 |
| Louisiana | 3,122 | $16.78 |
| Florida | 2,668 | $17.07 |
| Michigan | 2,339 | $16.86 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 24 | Prescribing Information |
| practitioner claims | 24 | Prescribing Information |
What changed for J0561
- 2011-01-01: J0561 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J0561?
J0561 is the HCPCS Level II code for injection, penicillin g benzathine, 100,000 units. Short descriptor: "Penicillin g benzathine inj".
How much does Medicare pay for J0561?
In 2024, the average Medicare payment was $16.61 per service (average allowed $20.49).
Does Medicare cover J0561?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J0561 can be billed per day?
24 on outpatient hospital claims; 24 on practitioner claims (NCCI medically unlikely edits).
Related J05 codes
- J0500 — Injection, dicyclomine hcl, up to 20 mg
- J0515 — Injection, benztropine mesylate, per 1 mg
- J0517 — Injection, benralizumab, 1 mg
- J0520 — Injection, bethanechol chloride, myotonachol or urecholine, up to 5 mg
- J0525 — Injection, cefotetan disodium, 10 mg
- J0528 — Injection, fosfomycin disodium, 20 mg
- J0558 — Injection, penicillin g benzathine and penicillin g procaine, 100,000 units
- J0565 — Injection, bezlotoxumab, 10 mg
- J0567 — Injection, cerliponase alfa, 1 mg
- J0570 — Buprenorphine implant, 74.2 mg
- J0571 — Buprenorphine, oral, 1 mg
- J0572 — Buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine
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Next steps
- Run a reimbursement report for a device billed under J0561
- Watch J0561 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0561
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.