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HCPCS code J2516: Pentamidine injection, per 1 mg2026 Medicare rate & RVUs

Pentamidine isethionate injection is reported by milligram for injectable treatment, commonly of Pneumocystis pneumonia, when Medicare coverage permits.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · J2516

Pentamidine injection, per 1 mg

Office or facility?

Work RVUs
0
Total RVUs
0.00
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for J2516 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What J2516 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What J2516 covers

Pentamidine isethionate is an injectable antimicrobial used most commonly to treat Pneumocystis jirovecii pneumonia, particularly in immunocompromised patients. A clinician administers the drug by injection, commonly by IV infusion for this infection, in a hospital or outpatient setting. This code identifies the drug, not the administration service. The inhaled form of pentamidine is represented by a different HCPCS code.

CMS excludes this code from the physician fee schedule under status E. When Medicare covers the drug, it pays through another payment method; HCPCS classifies it as a Part B drug generally paid using CMS quarterly Average Sales Price drug pricing files. Coverage is left to the Medicare contractor’s judgment. Each billing unit represents 1 mg of pentamidine isethionate, so report the number of milligrams administered as the corresponding number of units.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where J2516 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

J2516 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

J2516 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
J2516 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the J2516 rate is calculated

Each of J2516’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · J2516

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.00

0.00 RVUs× 1.000 GPCI

Practice expense0.00

0.00 RVUs× 1.000 GPCI

Malpractice0.00

0.00 RVUs× 1.000 GPCI

Adjusted RVUs

0.0000

Conversion factor

$33.4009

Medicare rate

$0.00

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for J2516

J2516 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Place of service · J2516

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

—

J2516 isn’t priced in this setting.

J2516 compared with similar codes

Compare codes · National

J2516 vs J2545 vs J2515: Medicare rates

Office or facility?

  • J2516

    Pentamidine injection, per 1 mg0 wRVU

    Not priced

  • J2545

    Inhaled pentamidine, per 300 mg0 wRVU

    Not priced

  • J2515

    Pentobarbital injection, per 50 mg0 wRVU

    Not priced

How to choose

J2545Inhaled pentamidinePer 300 mg
Choose J2516 for injectable pentamidine reported per milligram. J2545 represents the inhaled form and has a different unit basis.
J2515Pentobarbital injectionPer 50 mg
J2515 is pentobarbital sodium injection, a different drug. The similar code number and shared word stem do not indicate the same medication.

Codes related to J2516

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to J2516
CodeHow it relatesNational office range
Used instead
J2545Inhaled pentamidine, per 300 mgRepresents inhaled pentamidine rather than the injectable drug.No office rate
Often billed with
96365IV drug infusion, initial, first hourMay accompany a separately reportable qualifying IV infusion administration.$58.20–$93.27
96372SC/IM injection, therapeutic, prophylactic, or diagnosticMay accompany separately reportable intramuscular administration when that route is used.$13.88–$19.97

J2516 billing questions

How many units should be reported?

Each unit represents 1 mg of pentamidine isethionate. Report one unit for each milligram administered.

How does this code differ from J2545?

J2516 identifies injectable pentamidine by the milligram. J2545 identifies inhaled pentamidine and uses a non-compounded unit basis.

Does Medicare pay this code under the physician fee schedule?

No. CMS assigns status E, excluding it from the physician fee schedule; when covered, payment is through another method, generally using the quarterly ASP drug pricing files for Part B drugs.

Does Medicare cover pentamidine automatically?

No. Medicare coverage is left to the Medicare contractor’s judgment.

Is drug administration included in this code?

J2516 identifies the drug, not the administration service. A qualifying administration service may be reported separately when supported by the documented route and service.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates

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