J2785 HCPCS code: Injection, regadenoson, 0.1 mg
J2785 is the HCPCS Level II code for injection, regadenoson, 0.1 mg. In 2024 Medicare paid an average of $5.33 per service for J2785 across 2,260,631 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 4 per day on outpatient hospital claims. Medicare volume rose 4% from 2022 to 2024 (2,183,212 to 2,260,631 services). In 2024, about 9,511 clinicians billed Medicare for J2785 for 567,854 beneficiaries; California, Florida, Texas accounted for 41% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2009-01-01 |
| Last action effective | 2014-01-01 |
Who bills J2785 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 9,511 |
| Medicare beneficiaries | 567,854 |
| States with claims | 53 |
| Share of services in top 3 states (California, Florida, Texas) | 41% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J2785, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 2,183,212 | 547,061 | $60.12 | $47.80 |
| 2023 | 2,228,526 | 558,009 | $53.37 | $42.36 |
| 2024 | 2,260,631 | 567,854 | $6.77 | $5.33 |
States with the most J2785 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 328,447 | $5.41 |
| Florida | 307,688 | $5.40 |
| Texas | 284,931 | $5.27 |
| New York | 162,390 | $5.34 |
| Arizona | 115,564 | $5.48 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 4 | Prescribing Information |
| practitioner claims | 4 | Prescribing Information |
Medicare policy articles for this code
- A56494: Billing and Coding: Cardiovascular Nuclear Medicine (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A56781: Billing and Coding: Transthoracic Echocardiography (TTE) (National Government Services, Inc. (MAC - Part A, MAC - Part B))
- A57306: Billing and Coding: Transthoracic Echocardiography (TTE) (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
Covered diagnoses (1,725 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| I20.0 | Unstable angina | 3 |
| I20.1 | Angina pectoris with documented spasm | 3 |
| I20.81 | Angina pectoris with coronary microvascular dysfunction | 3 |
| I20.89 | Other forms of angina pectoris | 3 |
| I21.01 | ST elevation (STEMI) myocardial infarction involving left main coronary artery | 3 |
| I21.02 | ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery | 3 |
| I21.09 | ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall | 3 |
| I21.11 | ST elevation (STEMI) myocardial infarction involving right coronary artery | 3 |
| I21.19 | ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall | 3 |
| I21.21 | ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery | 3 |
Showing 10 of 1,725. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J2785
- 2009-01-01: J2785 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J2785?
J2785 is the HCPCS Level II code for injection, regadenoson, 0.1 mg. Short descriptor: "Regadenoson injection".
How much does Medicare pay for J2785?
In 2024, the average Medicare payment was $5.33 per service (average allowed $6.77).
Does Medicare cover J2785?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J2785?
Medicare policy articles that cite J2785 list 1,725 covered ICD-10-CM diagnosis codes across 3 articles. The most cited include I20.0 (Unstable angina), I20.1 (Angina pectoris with documented spasm), I20.81 (Angina pectoris with coronary microvascular dysfunction). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J2785 can be billed per day?
4 on outpatient hospital claims; 4 on practitioner claims (NCCI medically unlikely edits).
Related J27 codes
- J2700 — Injection, oxacillin sodium, up to 250 mg
- J2704 — Injection, propofol, 10 mg
- J2710 — Injection, neostigmine methylsulfate, up to 0.5 mg
- J2720 — Injection, protamine sulfate, per 10 mg
- J2724 — Injection, protein c concentrate, intravenous, human, 10 iu
- J2725 — Injection, protirelin, per 250 mcg
- J2730 — Injection, pralidoxime chloride, up to 1 gm
- J2760 — Injection, phentolamine mesylate, up to 5 mg
- J2765 — Injection, metoclopramide hcl, up to 10 mg
- J2770 — Injection, quinupristin/dalfopristin, 500 mg (150/350)
- J2777 — Injection, faricimab-svoa, 0.1 mg
- J2778 — Injection, ranibizumab, 0.1 mg
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Next steps
- Run a reimbursement report for a device billed under J2785
- Watch J2785 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2785
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.