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HCPCS J1951

Excluded from PFS

J1951 · PFS Q3 2025 · Historical

Status E is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS RVU25CJuly 1 – September 30, 2025

HCPCS J1951 has no published national rate. It carries status E (excluded) in the Q3 2025 release. A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead. The blank amount means unpriced, not $0.

PFS status evidence

Physician relative value file (Q3 2025) · rvu25c-updated-06-05-2025.zip (PPRRVU2025_Jul.csv row 16,568)
Inspect PFS status evidence
Code
J1951
Release
Q3 2025, revision 1
Result
Excluded from PFS

Citations

Every input comes from a published CMS file. Open the same file at the row shown and the values match.

  • Shows this code’s PFS status (E). Result: Excluded from PFS.

    Physician relative value file (PPRRVU)CMS RVU25CJuly 1 – September 30, 2025

    This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.

    PPRRVU2025_Jul.csv row 16,568 in rvu25c-updated-06-05-2025.zip

    A HCPCS
    J1951
    B Modifier
    blank
    D Status code
    E
    In the CMS file

    Loading rows 16,566–16,570 of PPRRVU2025_Jul.csv…

    Download rvu25c-updated-06-05-2025.zip from CMS File fingerprint b7937472967288d5c4dcf43ecbc5d2d792e97d768c9f5ec9b1e88a99f3d0bbe7

Plain-text summary

Why is there no national PFS amount for J1951?

Its status indicator is E (excluded). A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead. Status E is not separately payable under the PFS.

About this code

Inj fensolvi 0.25 mg

Payment considerations Copy link

Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.

Other payment indicators (10)

Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.

Why would a Medicare claim for J1951 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

  • Its status indicator is E (excluded)—A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead. See status indicators

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

Which billing rules and modifiers apply? Copy link

Global period: what J1951's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

Can you bill it with another code? Copy link

Check a pair of codes Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit for the pair.

See every current NCCI pair for J1951 →

How has it changed? Copy link

Rate history by release Copy link

National Office (non-facility) amount for J1951 across quarterly releases.

Release Status Office Facility
Q4 2026 Oct 1, 2026 – present E — —
Q3 2026 Jul 1, 2026 – Sep 30, 2026 E — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 E — —
When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

Usage and related codes Copy link

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q3 2025 release (effective July 2025). National baselines use GPCI 1.000 and exclude sequestration. Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. CMS owns the code description shown for HCPCS Level II codes. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.

Physician relative value file (Q3 2025) · rvu25c-updated-06-05-2025.zip (PPRRVU2025_Jul.csv row 16,568)

Cite this rate

The citation names the release, so anyone can check it even after CMS publishes a newer one.

HCPCS J1951 National PFS baseline: No national PFS rate (Q3 2025; participating; whole service; GPCI 1.000; sequestration excluded). CMS RVU25C, PPRRVU2025_Jul.csv row 16,568. Localis. https://localishealth.com/hcpcs/J1951/2025/C