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

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

CMS RVU26DEffective Oct 1, 2026One payment locality

CMS doesn’t publish a rate for J2516 in Redding, CA.

Separate payment rules applyOffice (non-facility)
Separate payment rules applyHospital or facility

Check a contract rate as a % of Medicare · J2516 nationwide

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

We’ll open J2516 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Redding, CA
  2. What J2516 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. 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.

How Redding, CA compares for J2516

J2516 in Redding, CA vs other payment areas
  1. Redding, CA · this pageUnavailable
  2. Bakersfield, CA · CaliforniaUnavailable
  3. Chico, CA · CaliforniaUnavailable
  4. El Centro, CA · CaliforniaUnavailable
  5. Fresno, CA · CaliforniaUnavailable
  6. Hanford, CA · CaliforniaUnavailable
  7. Los Angeles, CA · CaliforniaUnavailable

Other areas in California first, then benchmark localities. Bars start at $0.

Every other payment area

J2516 in every other Medicare payment locality
Payment localityOfficeFacility
Madera, CACalifornia——
Merced, CACalifornia——
Modesto, CACalifornia——
Napa, CACalifornia——
Oxnard, CACalifornia——
Rest of CaliforniaCalifornia——
Riverside, CACalifornia——
Sacramento, CACalifornia——

J2516 rates by state

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

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

See J2516 in every payment locality

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.

How J2516 has changed in Redding, CA

J2516 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release
  1. January 1, 2026

    RVU26A

    No ratechanged toNo rate

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D, RVU20A, RVU20B, RVU20C, RVU20D, RVU21A, RVU21B, RVU21C, RVU21D, RVU22A, RVU22B, RVU22C, RVU22D, RVU23A, RVU23B, RVU23C, RVU23D, RVU24A, RVU24AR, RVU24B, RVU24C, RVU24D, RVU25A, RVU25B, RVU25C, RVU25D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01Separate payment rules applySeparate payment rules applyRVU26D
2026-07-01Separate payment rules applySeparate payment rules applyRVU26C
2026-04-01Separate payment rules applySeparate payment rules applyRVU26B
2026-01-01Separate payment rules applySeparate payment rules applyRVU26A
2025-10-01Not in this releaseNot in this releaseRVU25D
2025-07-01Not in this releaseNot in this releaseRVU25C
2025-04-01Not in this releaseNot in this releaseRVU25B
2025-01-01Not in this releaseNot in this releaseRVU25A
2024-10-01Not in this releaseNot in this releaseRVU24D
2024-07-01Not in this releaseNot in this releaseRVU24C
2024-04-01Not in this releaseNot in this releaseRVU24B
2024-03-09Not in this releaseNot in this releaseRVU24AR
2024-01-01Not in this releaseNot in this releaseRVU24A
2023-10-01Not in this releaseNot in this releaseRVU23D
2023-07-01Not in this releaseNot in this releaseRVU23C
2023-04-01Not in this releaseNot in this releaseRVU23B
2023-01-01Not in this releaseNot in this releaseRVU23A
2022-10-01Not in this releaseNot in this releaseRVU22D
2022-07-01Not in this releaseNot in this releaseRVU22C
2022-04-01Not in this releaseNot in this releaseRVU22B
2022-01-01Not in this releaseNot in this releaseRVU22A
2021-10-01Not in this releaseNot in this releaseRVU21D
2021-07-01Not in this releaseNot in this releaseRVU21C
2021-04-01Not in this releaseNot in this releaseRVU21B
2021-01-01Not in this releaseNot in this releaseRVU21A
2020-10-01Not in this releaseNot in this releaseRVU20D
2020-07-01Not in this releaseNot in this releaseRVU20C
2020-04-01Not in this releaseNot in this releaseRVU20B
2020-01-01Not in this releaseNot in this releaseRVU20A
2019-10-01Not in this releaseNot in this releaseRVU19D
2019-07-01Not in this releaseNot in this releaseRVU19C
2019-04-01Not in this releaseNot in this releaseRVU19B
2019-01-01Not in this releaseNot in this releaseRVU19A
2018-10-01Not in this releaseNot in this releaseRVU18D
2018-07-01Not in this releaseNot in this releaseRVU18C
2018-04-01Not in this releaseNot in this releaseRVU18B
2018-01-01Not in this releaseNot in this releaseRVU18AR1
2017-10-01Not in this releaseNot in this releaseRVU17D
2017-07-01Not in this releaseNot in this releaseRVU17C
2017-04-01Not in this releaseNot in this releaseRVU17B
2017-01-01Not in this releaseNot in this releaseRVU17A
2016-10-01Not in this releaseNot in this releaseRVU16D
2016-07-01Not in this releaseNot in this releaseRVU16C
2016-04-01Not in this releaseNot in this releaseRVU16B
2016-01-01Not in this releaseNot in this releaseRVU16A
2015-10-01Not in this releaseNot in this releaseRVU15D
2015-07-01Not in this releaseNot in this releaseRVU15C
2015-04-01Not in this releaseNot in this releaseRVU15B
2015-01-01Not in this releaseNot in this releaseRVU15A
2014-10-01Not in this releaseNot in this releaseRVU14D
2014-07-01Not in this releaseNot in this releaseRVU14C
2014-04-01Not in this releaseNot in this releaseRVU14B
2014-01-01Not in this releaseNot in this releaseRVU14A
2013-10-01Not in this releaseNot in this releaseRVU13D
2013-07-01Not in this releaseNot in this releaseRVU13C
2013-04-01Not in this releaseNot in this releaseRVU13B
2013-01-01Not in this releaseNot in this releaseRVU13AR

Price J2516 for an earlier date of service

Where the Redding, CA rate applies

Redding, CA is a Medicare payment area, not a city. Our Census mapping connects it to 32 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • Redding
  • Anderson
  • Bella Vista
  • Big Bend
  • Burney
  • Cassel
  • Castella
  • Centerville

Browse all communities in California

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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