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

CMS doesn’t publish a rate for J2516 in Utah.

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.

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 Utah compares for J2516

Every other payment area

J2516 rates by state

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

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.

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.

Codes related to J2516

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

How J2516 has changed in Utah

Price J2516 for an earlier date of service

Where the Utah rate applies

Utah is a Medicare payment area, not a city. Our Census mapping connects it to 334 cities and communities in Utah. Some span more than one payment area; confirm with the service ZIP.

• Alpine
• Alta
• Altamont
• Alton
• Amalga
• American Fork
• Aneth
• Annabella

Browse all communities in Utah

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