HCPCS Level II › J codes J2021 Inj, linezolid (hospira)Injection, linezolid (hospira), not therapeutically equivalent to j2020, 200 mg
Medicare coverage: Carrier judgment Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 6 units per day (clinical), rationale: Prescribing Information Outpatient hospital: max 6 units per day (clinical), rationale: Prescribing Information Medicare pricing for J2021 Medicare Part B drug payment limit (ASP, October 2026) J2021 payment limit: $31.611 per 200 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
NDCs that bill under J2021 (CMS ASP NDC-HCPCS crosswalk, October 2026) 00409-4883-01 Linezolid, Pfizer Inc: 30 billing units per package00409-4883-10 Linezolid, Pfizer Inc: 30 billing units per package (10 POUCH in 1 CASE / 1 BAG in 1 POUCH / 300 mL in 1 BAG)Physician Fee Schedule (CY 2026, RVU26D) Status E: excluded from the PFS by regulation.
Payer policies and prior authorization for J2021 Payer coverage policies that name J2021 J2021 appears in 3 coverage policies from Aetna, Centene.
Payer Policy Role in policy Reviewed Document Aetna Hyperbaric Oxygen Therapy (HBOT) (0172) listed, no stance Apr 21, 2026 payer document Aetna Injectable Medications (0020) listed, no stance (range J0278-J2543) Mar 5, 2026 payer document Centene Linezolid (Zyvox) (CP.PMN.27) covered if criteria are met Aug 1, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in VT.
AZ: $34.18 (outpatient_hospital), effective Jul 1, 2026 IL: $161.00 (practitioner), effective Apr 1, 2026 IN: $20.76 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2024 KS: $31.61 (default), effective Oct 1, 2026 KY: $0.00 (asc), effective Jan 1, 2026 LA: $34.18 (professional), effective Jul 1, 2026 MA: $12.19 (dme_rates), effective Mar 1, 2026 MS: $26.83 (comprehensive), effective Jul 1, 2026 NE: $34.17 (injectables), effective Jul 1, 2026 OH: $34.17 (provider_administered_drugs), effective Jul 1, 2026 OK: $34.18 (physician, non-facility), effective Jul 1, 2026 TX: $6.34 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Mar 1, 2026 VA: $34.17 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $34.18 (professional_administered_drugs), effective Jul 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.