HCPCS code J2516: Pentamidine injection, per 1 mg2026 Medicare rate & RVUs in Guam
Pentamidine isethionate injection is reported by milligram for injectable treatment, commonly of Pneumocystis pneumonia, when Medicare coverage permits.
CMS doesn’t publish an office rate for J2516 in Guam.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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.
J2516 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | Unavailable |
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
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
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J2516 isn’t priced in this setting.
J2516 compared with similar codes
Compare codes · National
J2516 vs J2545 vs J2515: Medicare rates
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.
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
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