How much does Medicare pay for HCPCS J2805?

Medicare allowed an average of $121.62 per service and paid $96.17 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $231.41, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J2805?

Injection, sincalide, 5 micrograms. It was billed 1,759 times to 1,744 Medicare beneficiaries by 77 providers in 2024.

Which specialty bills J2805 most?

Diagnostic Radiology, with 1,284 services from 58 clinicians. Next are Nuclear Medicine, Independent Diagnostic Testing Facility (IDTF), Family Practice.

HCPCS J2805

Injection, sincalide, 5 micrograms

$121.62Medicare-allowed amount per service, averaged across 1,759 services

Providers submitted

$231.41

Asking price, not received

Medicare allowed

$121.62

The fee schedule figure

Medicare paid

$96.17

Balance is patient coinsurance

Providers submitted an average of $231.41 for this code and Medicare allowed $121.62 — 1.9× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $96.17 (79%); the rest is the patient’s coinsurance and deductible.

Services: 1,759
Beneficiaries: 1,744
Providers billing it: 77
Total allowed: $213,930

What Medicare pays for HCPCS J2805

Across 1,759 services billed by 77 providers to 1,744 beneficiaries, Medicare allowed an average of $121.62 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

This is a drug or supply code rather than a service. The unit is usually a dose or a milligram, so the per-service figure is small by construction and the total is what carries meaning — read it alongside the service count rather than on its own.

Who bills J2805

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	1,284	1,270	$119.45	58
Nuclear Medicine	246	246	$127.37	7
Independent Diagnostic Testing Facility (IDTF)	162	161	$127.77	8
Family Practice	21	21	$127.29	1
Internal Medicine	18	18	$121.71	1
Pediatric Medicine	15	15	$132.15	1
Radiation Oncology	13	13	$128.76	1

J2805 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	282	$116.77	$95.06	16
Texas	228	$129.66	$103.42	12
Maryland	202	$129.87	$103.38	6
Arizona	139	$129.29	$102.85	5
New York	127	$128.10	$103.64	4
California	103	$122.08	$95.60	5
Massachusetts	90	$129.12	$103.72	1
North Carolina	90	$52.56	$73.08	4
Tennessee	81	$114.23	$100.30	5
Nevada	70	$126.00	$103.37	4
Mississippi	53	$127.91	$97.86	2
Illinois	41	$132.68	$99.60	1
Connecticut	40	$125.64	$102.33	1
Nebraska	37	$129.79	$102.74	2
Delaware	36	$132.88	$104.58	2
Pennsylvania	30	$130.17	$98.99	1
Michigan	25	$129.39	$102.54	1
Missouri	23	$127.62	$104.24	1
Colorado	23	$129.69	$102.73	1
Washington	14	$130.73	$101.39	1
Georgia	13	$98.40	$84.35	1
Virginia	12	$80.27	$60.68	1

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.