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J2516

J2516 – Pentamidine non-comp unit · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 3 NDCs crosswalked per 1 MG $0.160/unit ASP+6%

This page is curated, coded, and maintained by

Compiled from public FDA, CMS, DailyMed, NADAC, and related drug data sources. Editorial policy

📋 J2516 summary

J2516 is a HCPCS Level II J-code used to bill Pentamidine non-comp unit, billed per 1 MG. The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.

Brand names associated with J2516: Nebupent(J2516)*, Pentamidine Isethionate, Pentam

Code J2516 Billing unit 1 MG Payment limit $0.160/unit NDC-Crosswalk 3 Quarter Q3 2026 RxCUI Atlas Trace the drug concept →

⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.

🗂️ Key billing facts

HCPCS codeJ2516
DescriptorPentamidine non-comp unit
Billing unit1 MG
Payment limit / unit$0.160
Est. ASP / unit$0.151 est.
Mapped NDCs3
Data periodQ3 2026
Last updated2026-09-20

💊 About Pentamidine Oral Inhalation DRUG GUIDE

Pentamidine isethionate (NebuPent) inhaled via nebulizer is used to prevent Pneumocystis jiroveci pneumonia (PJP) — a serious lung infection — in high-risk HIV-infected patients.

These are patients who have already had at least one episode of PJP, or whose CD4+ T-cell count (a key immune system marker) is 200 or below.Pentam 300, the injectable form, is given intramuscularly (IM) or intravenously (IV) and is used to treat active PJP infections.

The two forms serve different purposes and are not interchangeable.

Read the full Pentamidine Oral Inhalation drug guide →
Clinical overview from our editorial drug guide for Pentamidine Oral Inhalation. For billing reference, see the sections above.

🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026

📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$0.160
Est. ASP / unit
$0.151 est.
Est. after 2% sequester
$0.157
HCPCS dosage
1 MG
The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly), Q3 2026.

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J2516 = 1 mg. Enter a regimen to convert dose → billing units and project a full course.
Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.

🔁 NDCs that bill under J2516 WITH EST. MEDICARE PAY

3 NDCs map to J2516. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($0.160/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
23155-0748-41 pentamidine isethionate 300 mg/300mg INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION Heritage 10 VIAL, SINGLE-DOSE in 1 CARTON (23155-74... 300 mg/300mg 3,000 $480.00 — ● Active CMS + PDAC
13925-0515-10 Pentamidine Isethionate 300 mg/300mg INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION Seton 10 VIAL in 1 TRAY (13925-515-10) / 300 mg... 300 mg/300mg 300 $48.00 — ● Active PDAC
63323-0113-10 Pentam 300 PENTAMIDINE ISETHIONATE 300 mg/3mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION Fresenius 10 VIAL in 1 TRAY (63323-113-10) / 3 mL i... 300 mg/3mL 300 $48.00 — ● Active PDAC
NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.

📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)

Total Part B spend
$5.4K
Claims
73
Beneficiaries
37
Spend / beneficiary
$144.80
Spend / claim
$73.39
Where J2516 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #708 of 824
#703 PREMARIN J1410 $6.2K #704 ORPHENADRINE CITRATE J2360 $6.1K #705 HYLENEX J3473 $6K #706 NOVACHOR 1 SQ CM** Q4194 $5.7K #707 MITOXANTRONE HCL J9293 $5.6K #708 NEBUPENT(J2516)* J2516 $5.4K #709 CALCIUM GLUCONATE-NA... J0612 $5.2K #710 DELESTROGEN* J1380 $5.1K #711 SYNOJOYNT, INJ., 1 M... J7331 $4.5K #712 FUROSEMIDE(J1938) J1938 $4.2K #713 AMIKACIN SULFATE J0278 $4.2K
Total claims — #657 of 824
#652 KEPPRA* J1953 75 #653 VASOPRESSIN-0.9% NAC... J2601 75 #654 CYGNUS DUAL PER SQ C... Q4282 75 #655 DOPAMINE HCL IN 5% D... J1265 74 #656 THYMOGLOBULIN J7511 74 #657 NEBUPENT(J2516)* J2516 73 #658 WILATE J7183 73 #659 BIZENGRI J9382 73 #660 PRIMATRIX** Q4110 73 #661 HEMOFIL M* J7190 72 #662 EPIEFFECT, PER SQ CM... Q4278 72

Full breakdown by period (1)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2026 (Q1) $5.4K 37 73 $144.80 $73.39
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.

🗺️ Where J2516 is utilized

⏳
The geographic utilization map is building for this code — it aggregates millions of CMS Part B claim lines, then caches the result. Refresh in a moment; if it doesn’t appear, this code may have no reportable Part B utilization.

📊 What bills under J2516

J-codes are billing codes often used for drugs billed under the medical benefit. This connects the billing code to the NDC package records it covers, by ingredient and labeler.

NDC products by ingredient
Pentamidine Isethionate 1
pentamidine isethionate 1
PENTAMIDINE ISETHIONATE 1
NDC products by labeler
Seton Pharmaceuticals 1
Heritage Pharmaceuticals Inc. d/b/... 1
Fresenius Kabi USA, LLC 1

🗃️ Data sources & freshness

Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.
HCPCS code & descriptor
CMS HCPCS Level II code file
Not available in current dataset
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Q3 2026 · as of 2026-09-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk + DMEPDAC (PDAC)
3 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
Not available for mapped NDCs
Utilization & spend
CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners
Latest data year 2026
Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.

⚠️ Practical billing caveats

  • A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
  • Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
  • Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
  • Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
  • The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
  • Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.

❓ J2516 billing FAQ

What is HCPCS code J2516?
J2516 is a HCPCS Level II J-code used to bill Pentamidine non-comp unit under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J2516?
One unit of J2516 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of J2516 should I bill?
Divide the dose administered by the code's unit size (1 MG) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for J2516?
The Medicare Part B payment limit is $0.160 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $0.157 per unit. Payment limits are revised quarterly.
Which NDCs bill under J2516?
3 NDCs currently map to J2516 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.
Does a crosswalk mean J2516 is covered?
No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.
For professional billing reference only — verify against the current CMS files before submitting claims.