J2805 HCPCS code: Injection, sincalide, 5 micrograms
J2805 is the HCPCS Level II code for injection, sincalide, 5 micrograms. In 2024 Medicare paid an average of $95.61 per service for J2805 across 3,512 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 3 per day on outpatient hospital claims. Medicare volume rose 4% from 2022 to 2024 (3,391 to 3,512 services). In 2024, about 688 clinicians billed Medicare for J2805 for 3,453 beneficiaries; Florida, Texas, Maryland accounted for 33% 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 | 2006-01-01 |
| Last action effective | 2006-01-01 |
Who bills J2805 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 688 |
| Medicare beneficiaries | 3,453 |
| States with claims | 36 |
| Share of services in top 3 states (Florida, Texas, Maryland) | 33% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J2805, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 3,391 | 3,363 | $110.34 | $87.31 |
| 2023 | 4,191 | 4,153 | $116.11 | $91.80 |
| 2024 | 3,512 | 3,453 | $121.07 | $95.61 |
States with the most J2805 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 545 | $93.91 |
| Texas | 345 | $102.22 |
| Maryland | 261 | $101.75 |
| Arizona | 257 | $100.84 |
| New York | 219 | $100.62 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 3 | Prescribing Information |
| practitioner claims | 3 | Prescribing Information |
What changed for J2805
- 2006-01-01: J2805 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 J2805?
J2805 is the HCPCS Level II code for injection, sincalide, 5 micrograms. Short descriptor: "Sincalide injection".
How much does Medicare pay for J2805?
In 2024, the average Medicare payment was $95.61 per service (average allowed $121.07).
Does Medicare cover J2805?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J2805 can be billed per day?
3 on outpatient hospital claims; 3 on practitioner claims (NCCI medically unlikely edits).
Related J28 codes
- J2800 — Injection, methocarbamol, up to 10 ml
- J2801 — Injection, risperidone (rykindo), 0.5 mg
- J2802 — Injection, romiplostim, 1 microgram
- J2804 — Injection, rifampin, 1 mg
- J2806 — Injection, sincalide (maia), not therapeutically equivalent to j2805, 5 micrograms
- J2810 — Injection, theophylline, per 40 mg
- J2820 — Injection, sargramostim (gm-csf), 50 mcg
- J2840 — Injection, sebelipase alfa, 1 mg
- J2850 — Injection, secretin, synthetic, human, 1 microgram
- J2860 — Injection, siltuximab, 10 mg
- J2865 — Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J2805
- Watch J2805 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2805
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.