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CPT code 74176 covers a CT scan of the abdomen and pelvis performed without cont...
Last Updated: August 24, 2026
Key takeaways
J0561 covers injection of penicillin G benzathine, billed in increments of 100,000 units.
Divide the dose by 100,000 to get the unit count. A 2.4 million unit dose bills as 24 units.
The CDC’s standard adult dose for primary or secondary syphilis is 2.4 million units, given as one intramuscular injection.
Medicare pays J0561 at ASP plus 6%, and the rate changes every quarter. Verify it against the current CMS pricing file.
J0560 and J0570 were deleted at the end of 2010. Only J0558 and J0561 are still billable today.
J0561 is a HCPCS Level II code maintained by the Centers for Medicare and Medicaid Services (CMS). It represents one billable unit of 100,000 units of penicillin G benzathine, given by intramuscular injection. Unlike CPT codes, HCPCS J-codes pay for the drug rather than the act of administering it.
Unit conversion is where J0561 claims fail most often. A 1.2 million unit dose bills as 12 units, and a 2.4 million unit dose bills as 24.
J0561 covers the drug component only. Practices bill the injection itself with CPT 96372. Both codes normally appear on the same claim for an outpatient intramuscular injection visit.
How to calculate billing units for J0561
Every dose has to be converted to a unit count before submission. Divide the prescribed dose in units by 100,000. The result is the number of J0561 units to report on the claim.
The 2.4 million unit dose (24 units) is the CDC-recommended single dose for adult primary, secondary, and early latent syphilis. Late latent syphilis takes three weekly 2.4 million unit doses, billed as 24 units each week.
The 1.2 million unit dose (12 units) is used for streptococcal pharyngitis and for monthly rheumatic fever prophylaxis. Maryland’s state billing manual shows the same conversion for both Bicillin products.
Billing the wrong unit count is the top denial trigger for J0561 claims. A single-unit submission for a 2.4 million unit dose underpays the practice by a factor of 24. Always check the units field before you submit.
Practices with structured clinical documentation can build the dose-to-unit conversion into the intake form itself. The conversion then happens once, at the point of care, instead of being repeated by hand at billing time.
J0561 Medicare reimbursement and fee schedule
Medicare pays for J0561 under Part B drug coverage using average sales price (ASP) methodology. The rate is ASP plus 6%, applied to each 100,000-unit increment. Under 42 CFR 414.904, ASP-based rates update every calendar quarter as manufacturers report new pricing data.
Because rates change quarterly, any dollar figure in a reference guide can be stale within 90 days. Verify the current allowable against the CMS ASP pricing files before quoting a rate to a payer or a patient.
Checking the current quarterly rate
The J0561 allowable moves with every quarterly ASP filing, so pull the figure for the quarter you are billing. Third-party rate tables can lag the official CMS release by weeks. The CMS Physician Fee Schedule lookup returns the current allowable by HCPCS code.
For a 1.2 million unit dose, multiply the per-unit allowable by 12. For a 2.4 million unit dose, multiply by 24. Those figures cover the drug alone. The CPT 96372 administration fee is calculated separately from the physician fee schedule.
Diagnosis codes commonly paired with J0561
Most payers require a supporting ICD-10-CM diagnosis code on every J0561 claim. Three clinical categories account for the bulk of that billing. Coverage policies are payer-specific, so confirm medical necessity requirements before assuming a pairing is universally accepted.
Neurosyphilis is the exception to all of this. CDC guidance treats it with intravenous aqueous crystalline penicillin G, which is a different drug from benzathine penicillin. A neurosyphilis diagnosis therefore does not support a J0561 claim.
Those syphilis codes are the primary medical necessity anchor for a benzathine penicillin injection. A visit may also carry an unrelated diagnosis such as R37, which does not support J0561 on its own.
J-codes bill by unit, so inventory management software that tracks vials and wastage protects both compliance and margin.
Billing J0561 alongside CPT 96372
J0561 reimburses the drug only, so the injection needs its own administration code. CPT 96372 covers a therapeutic, prophylactic, or diagnostic injection given subcutaneously or intramuscularly. It is the standard administration pairing for a Bicillin L-A injection.
- J0561 pays for the penicillin G benzathine itself, per 100,000 units
- CPT 96372 pays for the intramuscular injection service
- Both codes belong on the same claim for an outpatient injection visit
- Some payers bundle 96372 into an evaluation and management visit on the same day, so verify bundling policy before assuming it pays separately
- 96372 cannot be billed for a self-administered injection, or during a separately billable infusion
- Administration codes for other injection sites, such as CPT 20604, pair with their own drug code in the same way
That record is what protects 96372 when a bundling audit lands. Drug injection codes such as CPT 20527 follow the same split between the drug and the service.
NDC reporting requirements on Medicaid claims
Medicaid requires the National Drug Code (NDC) on claims for J-code drugs, including J0561. Most states reject the claim outright without one. The NDC must match the product actually administered, not the reference NDC for the code family.
Bicillin L-A NDCs vary by vial size. The 1.2 million unit prefilled syringe (2 ml) and the 2.4 million unit prefilled syringe (4 ml) carry different numbers. Read the NDC off the packaging of the product you used, because manufacturing changes can reassign it.
Medicaid claims take the 11-digit NDC format, split 5-4-2 or 5-3-3 depending on the state. The qualifier N4 precedes the NDC on the CMS-1500 form. Missing or misformatted NDCs sit in the top three denial reasons for J0561.
The number then travels with the visit into claim generation, rather than being looked up again days later.
Related HCPCS codes: J0558, J0560, and J0570
Adjacent J-codes cover penicillin G benzathine in different formulations and unit increments. Two of them no longer exist. Payers cross-reference the billed HCPCS code against NDC records, and a mismatch invites an audit.
Only J0558 and J0561 are billable today. CMS deleted the fixed-dose codes J0560 and J0570 effective December 31, 2010, and rolled every dose size into the per-100,000-unit J0561. A claim carrying either deleted code rejects as invalid.
That leaves one distinction worth getting right. Bicillin C-R contains procaine penicillin alongside benzathine penicillin, and it is billed under J0558. Bicillin C-R is not an accepted syphilis treatment, so coding it as J0561 is a clinical error as well as a billing one.
Billing during the Bicillin shortage
Bicillin L-A has been on the FDA drug shortage list for several years. Some states now authorize temporary coverage of imported alternatives under J0561. Check current availability in the FDA drug shortage database before planning a substitution.
Two imported products are in play. Extencilline, a Sandoz benzathine benzylpenicillin, was the first to be authorized for emergency import. Lentocilin, a benzathine benzylpenicillin tetrahydrate, joined it in August 2025 under co-authorization by North Carolina Medicaid and other state programs.
Neither product is FDA-approved for the US market. Both enter under temporary import authorization, which means coverage is state-specific and time-limited. North Carolina Medicaid and South Carolina DHHS have issued bulletins for billing them under J0561, and California’s Medi-Cal published similar guidance.
- Bill Extencilline or Lentocilin under J0561 using the same per-100,000-unit math as Bicillin L-A
- Report the imported product’s own NDC on Medicaid claims, as it differs from every Bicillin L-A NDC
- Some states require a modifier or prior authorization for a shortage substitution
- Medicare Part B coverage of an imported product can differ from Medicaid, so verify it separately
- Record the shortage and the substitution in the patient chart to defend the claim on audit
Check your state Medicaid agency’s current bulletin before every substitution claim, because these authorizations expire. Practices juggling substitutions alongside their medical office compliance obligations should capture the reason for the swap at the time of administration. Reconstructing it months later, after a denial, rarely holds up.
Pro Tip
When you bill Extencilline or Lentocilin under J0561, keep the state Medicaid bulletin that authorizes coverage in your billing records. If a payer denies the claim for an unrecognized drug product, that bulletin is your primary appeal document.
Documentation requirements and common denial reasons
Clean J0561 claims share a consistent documentation pattern. Miss any element below and the denial is predictable.
- Drug administered: the exact product name, vial size, lot number, and NDC
- Dose in units: record “1,200,000 units”, not “Bicillin 1.2M”
- Route and site: confirm intramuscular administration and the injection site in the note
- Diagnosis: link the ICD-10 code to a documented clinical indication
- Prescriber order: signed and dated in the chart before administration
- Units billed match dose: the claim’s unit count equals the dose divided by 100,000
The denials cluster into three causes. Wrong unit count is the most frequent, usually 1 or 2 units billed for a 12-unit or 24-unit dose. Missing or misformatted NDC on a Medicaid claim comes second. Third is a diagnosis the payer’s policy does not accept for J0561.
The same checklist works anywhere injections are routine. Build it into the drug administration note and an audit becomes a retrieval job rather than an investigation.
Related HCPCS codes
- HCPCS code J1885 — Ketorolac
- HCPCS code J0586
- HCPCS code J0588 — Xeomin billing, reimbursement, and indications
- HCPCS Code J0610 — Calcium gluconate injection, billing, and J0612 crosswalk
How Pabau prevents J0561 unit and NDC errors
In most practices the claim is reconstructed after the visit. A biller reads the clinical note, works out the dose, converts it to units, then hunts down the NDC and the lot number. Every one of those steps is a chance to transpose a digit.
Practice management software like Pabau captures those fields during the visit instead. A drug administration template holds the product, the dose in units, the lot number, the NDC, and the ICD-10 code as structured fields. Nothing depends on free-text notes.
Your billing team stops chasing missing numbers and spends its time on the claims that genuinely need judgment.
Practices standardizing their broader practice management software workflows can apply the same structured capture to every J-code they bill. One template pattern covers penicillin injections, vaccines, and biologics alike.
Catch J-code billing errors before the payer does
Pabau captures the dose in units, the NDC, and the diagnosis in one drug administration record, then carries them onto the claim. Your team submits cleaner Medicare and Medicaid claims with less rework.
Conclusion
J0561 is a simple code with one expensive failure mode. The dose is written in units, the claim is billed in hundred-thousands, and somebody has to do that conversion.
So put the conversion somewhere it cannot be skipped. A drug administration template that asks for the dose in units, the NDC, and the diagnosis turns claim preparation into data entry. The same template answers the audit if one ever arrives.
One caveat is worth carrying with you. The rate you verified last quarter is not the rate you will be paid this quarter. Check the ASP file every time you quote a figure. Book a demo to see how Pabau records dose, NDC, and diagnosis in a single visit.
Continue your research
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Tracking a device code through the quarterly fee schedule? HCPCS code C1785 sets out dual chamber pacemaker billing and where its rate is published.
Pairing a skin diagnosis with treatment? ICD-10 code L88 is a coding reference for pyoderma gangrenosum, including the documentation payers expect.
Frequently asked questions
What is HCPCS code J0561 used for?
HCPCS code J0561 is the billing code for injection of penicillin G benzathine, billed per 100,000 units under Medicare Part B and Medicaid. It covers Bicillin L-A, and equivalent benzathine penicillin formulations, given intramuscularly for syphilis, streptococcal pharyngitis, and long-term rheumatic fever prophylaxis. The code covers the drug cost only. The injection administration is billed separately using CPT 96372.
How many units of J0561 do I bill for a Bicillin L-A 1.2 million unit dose?
Bill 12 units of J0561 for a 1.2 million unit Bicillin L-A dose. The code is billed per 100,000 units, so divide the total dose by 100,000: 1,200,000 / 100,000 = 12. A 2.4 million unit dose bills as 24 units, and a 600,000 unit dose bills as 6 units. Submitting 1 unit for any of these doses causes significant underpayment or denial.
What is the difference between J0558, J0560, and J0561?
J0558 covers Bicillin C-R, the combination product containing penicillin G benzathine and penicillin G procaine. Bicillin C-R is not an accepted syphilis treatment, so J0558 must never be used in place of J0561. J0560, the old fixed-dose code for 600,000 units, was deleted effective December 31, 2010 and is no longer billable. J0561 is the primary per-100,000-unit code for Bicillin L-A and the correct code for syphilis treatment.
Can J0561 be billed for neurosyphilis treatment?
No. CDC guidance treats neurosyphilis with intravenous aqueous crystalline penicillin G, which is a different drug from benzathine penicillin. That drug carries its own HCPCS code, so a neurosyphilis diagnosis does not support a J0561 claim. Benzathine penicillin, and therefore J0561, applies to primary, secondary, and latent syphilis.
Does Medicaid cover J0561?
Yes, Medicaid covers J0561 in all states, though coverage policies, NDC reporting requirements, and prior authorization rules vary by state program. NDC reporting is mandatory on Medicaid claims for J0561 in most states, and a missing NDC is a leading denial cause. Some states also require specific modifiers. Check your state Medicaid agency’s drug coverage policy for current requirements.
Can imported penicillin be billed under J0561 during the Bicillin shortage?
Yes, in states that have issued temporary Medicaid coverage bulletins authorizing it. North Carolina Medicaid, South Carolina DHHS, and California’s Medi-Cal have each issued guidance permitting imported benzathine benzylpenicillin under J0561. Extencilline and Lentocilin both fall under these authorizations, with Lentocilin added in August 2025. Coverage is temporary and state-specific, so verify the current status and report the imported product’s own NDC.
What is the Medicare reimbursement rate for J0561?
Medicare pays J0561 at ASP plus 6% per unit, updated quarterly. Because rates change every 90 days, no single dollar figure stays current for long. Verify the active payment allowable using the CMS ASP pricing files or the CMS Physician Fee Schedule lookup tool. Filter by J0561 and the current quarter’s effective date.
