Summary & Overview
HCPCS J2806: Sincalide (maia) Injection, 5 Micrograms
HCPCS Level II code J2806 denotes a 5 microgram injection of sincalide (maia), a diagnostic agent used to stimulate gallbladder contraction during imaging studies. Nationally, this code matters for facilities and payers because it identifies a specific, nontherapeutically equivalent formulation relative to J2805, affecting billing specificity and coverage determinations for diagnostic hepatobiliary procedures.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. The publication outlines how these payers commonly approach coverage for diagnostic medication administrations, and where J2806 fits into payer policy frameworks.
Readers will find a concise overview of the clinical context for sincalide use, the typical sites of service where the injection is administered, and the implications of the code’s non-equivalent designation. The report also summarizes available billing benchmarks, common modifier usage patterns, and any notable recent policy updates impacting coding and claims processing. Where payer-specific details are not provided in the source, the publication notes that data are not available in the input.
Billing Code Overview
HCPCS Level II code J2806 represents an injection of sincalide (maia), specified as not therapeutically equivalent to J2805, in a 5 microgram dose. This code describes a medication administration service for a synthetic cholecystokinetic agent used to stimulate gallbladder contraction for diagnostic imaging procedures.
Service type: Diagnostic medication administration for gallbladder stimulation
Typical site of service: Hospital outpatient imaging suites, ambulatory surgery centers, and diagnostic radiology departments
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult referred for a hepatobiliary imaging study when gallbladder dysfunction is suspected. The patient presents with postprandial right upper quadrant discomfort, dyspepsia, or persistent biliary-type pain despite normal ultrasound findings. The clinician orders a cholescintigraphy (HIDA scan) with pharmacologic stimulation using sincalide (cholecystokinin analog) to assess gallbladder ejection fraction.
The clinical workflow: the patient arrives at an outpatient nuclear medicine or hospital radiology department. Pre-procedure screening includes allergy review, pregnancy status, and recent opioid or octreotide use that could affect results. Intravenous access is obtained, and the radiopharmaceutical for HIDA imaging is administered. At the appropriate time point, J2806 (sincalide 5 micrograms) is injected intravenously to stimulate gallbladder contraction. Dynamic imaging continues to measure gallbladder emptying and calculate ejection fraction. Post-procedure, images and quantitative results are documented in the radiology/nuclear medicine report and correlated with clinical presentation for diagnosis and management decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when sincalide administration requires substantially greater effort or time than usual, documented and justified. |