Summary & Overview
HCPCS J2561: Phenobarbital Sodium Injection, 1 mg
HCPCS Level II code J2561 denotes the injection of phenobarbital sodium (sezaby) at a unit measure of 1 mg. As an HCPCS Level II drug code, it is used on medical claims to identify the administered parenteral medication separate from procedural services. Nationally, accurate reporting of this code affects drug utilization tracking, payer adjudication, and pharmacy billed services across acute and ambulatory care settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for phenobarbital injections, typical sites of service where J2561 is billed, and common billing practices tied to parenteral drug codes. The publication summarizes national reimbursement and coverage considerations, benchmark use cases, and documentation elements typically associated with HCPCS drug reporting. Where specific payer policies or benchmarks are not provided, the note "Data not available in the input" is used.
This resource is intended for revenue cycle professionals, clinical coders, and policy analysts seeking clear guidance on the purpose and billing context of J2561, including where to look for payer-specific coverage and supervisory requirements.
Billing Code Overview
HCPCS Level II code J2561 describes the injection of phenobarbital sodium (sezaby), dosed per 1 mg. This code represents an administered pharmaceutical agent intended for use when phenobarbital therapy is required.
-
Service type: Injectable medication administration (parenteral drug service)
-
Typical site of service: Hospital inpatient or outpatient settings, emergency department, ambulatory infusion centers, and other clinical locations where parenteral medications are administered.
Clinical & Coding Specifications
Clinical Context
A 2-year-old child with a history of generalized tonic-clonic seizures presents to the pediatric emergency department with breakthrough seizures despite maintenance anticonvulsant therapy. The emergency physician orders an intravenous anticonvulsant because the patient cannot take oral medication and rapid titration is required. Pharmacy prepares J2561 (phenobarbital sodium injection, sezaby) and the medication is administered by the ED nurse per weight-based dosing. Post‑administration, the patient is observed in the ED or admitted to an inpatient pediatric unit for monitoring of respiratory status, hemodynamics, and seizure control. Nursing documents medication lot, dose (mg), route (IV), time, and any immediate adverse effects; clinicians document indication, informed consent when applicable, response to therapy, and plan for ongoing antiseizure management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
52 | Reduced services | When less than the full dose or a partial administration is provided (e.g., incomplete infusion due to adverse reaction). |
53 | Discontinued procedure |