Summary & Overview
HCPCS Level II J2805: Sincalide Injection, 5 Micrograms
HCPCS Level II code J2805 denotes a 5 microgram injection of sincalide, a synthetic cholecystokinin analog used to provoke gallbladder contraction for diagnostic imaging. Nationally, this code matters for facilities that perform hepatobiliary and gallbladder functional studies because it identifies a specific injectable diagnostic agent that influences both clinical workflows and billing documentation.
Key payers commonly engaged with this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coding intent, typical sites of service, and the clinical context for use. The publication also summarizes payer coverage patterns and benchmarks where available, highlights relevant policy updates affecting injectable diagnostic agents, and situates J2805 within service-line and billing workflows.
This summary is intended to inform billing staff, revenue managers, and clinical leaders about the role of J2805 in diagnostic imaging encounters, provide clarity on documentation expectations, and present the types of analyses typically included in a full report (coverage considerations, reimbursement benchmarks, and policy notes). Data not available in the input will be noted where applicable in the complete publication.
Billing Code Overview
HCPCS Level II code J2805 describes an injection of sincalide, 5 micrograms. This medication is a synthetic cholecystokinin analog used primarily to stimulate gallbladder contraction and aid diagnostic imaging procedures involving biliary and gallbladder function.
Service Type: Diagnostic injectable medication
Typical Site of Service: Outpatient imaging centers, hospital outpatient departments, and specialty clinics
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred for a hepatobiliary scintigraphy (HIDA) scan to evaluate gallbladder function or suspected biliary dyskinesia. The patient presents to a nuclear medicine or radiology outpatient imaging center. The clinical workflow: intake and history review (allergies, pregnancy status, recent opioid use), IV placement for administration, baseline vital signs, and optional EKG per facility protocol. The nuclear medicine technologist or radiologist prepares and administers J2805 (sincalide, 5 micrograms) intravenously as a cholecystokinetic agent to stimulate gallbladder contraction. Dynamic gamma camera imaging is performed before, during, and after infusion to calculate gallbladder ejection fraction and assess for cystic duct obstruction or leak. Post-procedure monitoring includes observation for adverse reactions (nausea, flushing) and documentation of dose, lot number, route, and performing provider. Results and ejection fraction are reported to the referring clinician for management decisions such as surgical referral for cholecystectomy or further hepatobiliary evaluation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Physician or practitioner billing for the usual, expected service | Use when the ordering/performing physician bills for the service as the primary provider |
22 | Increased procedural services | Use when additional work beyond usual is documented (complex dosing, prolonged monitoring) |
23 | Unusual anesthesia | Rare for this injection; use if anesthesia beyond local needs was required and documented |
25 | Significant, separately identifiable E/M service | Use when a separate evaluation/management visit is performed on the same day as the injection |
52 | Reduced services | Use if the procedure was partially reduced or not completed and documented |
53 | Discontinued procedure | Use when the procedure was started but stopped due to patient condition or complication |
62 | Two surgeons | Use if two physicians of different specialties actively perform the service in a collaborative manner (rare) |
78 | Unplanned return to the operating/procedure room following initial procedure | Use if an unexpected repeat procedure related to initial service occurs same day |
80 | Assistant surgeon | Use when an assistant surgeon provides documented assistance (rare for this injection) |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Use if an APP documents assisting role applicable under payer rules |
JW | Drug discarded/not administered to any patient | Use to indicate wastage of single-dose vial drug when billed separately as allowed by payer |
JZ | No wastage, full dose administered | Use to certify the entire vial/dose was administered with no discard |
GA | Waiver of liability statement on file | Use when voluntary payer denial waiver is on file for an item/service |
QK | Medical direction of two, three, or four concurrent anesthesia procedures | Use only if anesthesia medical direction is relevant and documented |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RH0000X | Radiology - Nuclear Medicine | Performs hepatobiliary scintigraphy and interprets images |
2085R0200X | Diagnostic Radiology | May perform and interpret nuclear medicine studies in some settings |
363L00000X | Nurse Practitioner | Administers medication and manages patient care in outpatient imaging |
367H00000X | Physician Assistant | May administer and document procedure under supervising physician |
208000000X | Diagnostic Radiology (alternative) | Applicable where institutional credentialing differs |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K81.1 | Acute cholecystitis | Evaluated with HIDA when obstruction or acute gallbladder inflammation is suspected |
K81.9 | Cholecystitis, unspecified | Used when cholecystitis is suspected but not specified; HIDA helps assess function and obstruction |
K82.1 | Calculus of gallbladder without cholecystitis | Biliary colic patients undergo HIDA to assess gallbladder ejection fraction and guide management |
K82.9 | Disease of gallbladder, unspecified | Non-specific gallbladder disease where functional testing is indicated |
R10.11 | Right upper quadrant pain | Common presenting symptom prompting hepatobiliary imaging to evaluate biliary causes |
K83.1 | Obstruction of bile duct | HIDA can assess biliary excretion patterns and drainage when obstruction is a concern |
R11.2 | Nausea with vomiting, unspecified | Symptom that may be part of biliary disease presentation and observed during testing |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
78830 | Hepatobiliary imaging; with pharmacologic agent (e.g., sincalide) | Primary imaging code commonly reported for HIDA scan performed with J2805 to stimulate gallbladder emptying |
96372 | Therapeutic, prophylactic, or diagnostic injection (intramuscular or subcutaneous) | Sometimes used for administration of injectable agents when facility billing rules require an injection administration code (verify payer rules) |
36415 | Collection of venous blood by venipuncture | Used when blood draws are obtained for pre-procedure labs or pregnancy testing prior to administration |
99070 | Supplies and equipment additional to those usually included | Use for disposable supplies related to IV administration if payer allows separate supply charges |
93000 | Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report | Performed in selected patients with cardiac history before imaging if clinically indicated |