HCPCS code S0080 – Urine drug screen billing guide

Key takeaways

HCPCS Code S0080 describes injection, pentamidine isethionate, 300 mg, and one unit equals one 300 mg dose.

CMS deleted S0080 effective December 31, 2025, so it is valid only for dates of service through that day.

From January 1, 2026, pentamidine injection is billed as J2516, which counts one unit per 1 mg.

A full 300 mg vial that was one unit of S0080 is now 300 units of J2516.

Practice management software like Pabau keeps the updated drug code on each charge, so old S0080 lines stop reaching payers.

What is HCPCS Code S0080?

HCPCS Code S0080 is the Level II HCPCS code that describes injection, pentamidine isethionate, 300 mg. It sits in the S0012-S0197 range of non-Medicare drug codes. Medicaid programs and commercial payers used those codes for drugs that had no specific J-code.

CMS deleted S0080 effective December 31, 2025. Its replacement, J2516, took effect on January 1, 2026, according to the CMS HCPCS code set. The drug is the same, but the billing unit changed from 300 mg to 1 mg.

About pentamidine isethionate: the drug behind S0080

Pentamidine isethionate is an antimicrobial drug used to treat pneumonia caused by Pneumocystis in immunocompromised patients. The injectable product is sold as Pentam 300, a lyophilized powder in a 300 mg vial.

The Pentam 300 prescribing information sets the dose at 4 mg/kg once a day for 14 to 21 days. It is given by intramuscular or intravenous route only.

• Drug: pentamidine isethionate for injection (Pentam 300)
• Route: intramuscular or intravenous
• Vial strength: 300 mg per single vial
• Former billing unit: 300 mg per unit of S0080
• Current billing unit: 1 mg per unit of J2516

The label warns of severe hypotension, hypoglycemia, acute pancreatitis, and cardiac arrhythmias. Patients are monitored closely during and after each dose. Coders record the drug, dose, and units exactly as documented. Whether the dose was clinically appropriate stays with the prescriber.

Inhaled pentamidine is a separate product with its own codes. It is billed as J2545 or J7676, never as S0080 or J2516.

S0080 deletion and the J2516 replacement

The date of service decides which code goes on the claim. Doses given through December 31, 2025, are reported with S0080. Doses given from January 1, 2026, are reported with J2516.

A claim for a 2026 date of service that still carries S0080 is invalid. Payers reject it the same way they reject any code that was not active on that date.

Converting S0080 units to J2516 units

The unit change is where most 2026 errors start. A charge master that simply swaps the code and keeps a quantity of one bills 1 mg of drug instead of 300 mg. The comparison below shows the same vial billed three ways.

On Medicare claims, single-dose vial drugs also carry the JW or JZ modifier. JW reports the discarded amount on its own line, and JZ confirms none was discarded. For the 240 mg example, 60 units of J2516 would go on a JW line.

What to update before billing J2516

• Charge master and fee schedule entries that still map pentamidine injection to S0080
• The default quantity on the drug line, which must change from vials to milligrams
• Superbill and order set templates that print the old code
• Payer contracts or addenda that list S0080 by name

Billing guidelines for S0080 claims

S0080 still matters for 2025 dates of service. Corrected claims, late claims, and appeals for those dates use the code that was valid when the drug was given.

Payer coverage for S0080

Medicare Part B never recognized S-codes, so S0080 was never a Medicare code. Medicaid and commercial acceptance depended on each state program and payer contract.

Before J2516 existed, pentamidine injection had no specific J-code. Medicare claims for 2025 and earlier generally used J3490, the unclassified drug code, with the drug name and dose in the claim notes.

Rates for S0080 were never published by CMS. Each state Medicaid agency and each payer contract set its own amount per 300 mg unit.

Documentation requirements for pentamidine injection claims

The same record supports an S0080 claim for 2025 and a J2516 claim for 2026. Payers auditing drug claims look for a clear chain from the order to the administration record.

• Drug name and form: pentamidine isethionate for injection, not the inhaled product
• Dose in mg: the amount given, not just the vial size
• Units billed: 300 mg per unit for S0080, 1 mg per unit for J2516
• Wasted amount: the discarded mg from a single-dose vial, for the JW line on Medicare claims
• Route: intramuscular or intravenous, as ordered
• Date and time of administration: recorded in the administration record
• Ordering and administering providers: names and NPIs
• Medical necessity: the ICD-10-CM diagnosis that supports the order
• NDC and lot number: required by many Medicaid programs on drug claims

Missing unit math is a common reason for drug claim denials. A compliant superbill that records the mg given and the mg wasted lets billers calculate units without going back to the chart.

Related HCPCS and CPT codes for pentamidine billing

A pentamidine claim often needs an administration code alongside the drug code. The table below lists the codes coders meet most often around S0080.

Rejections after January 1 often carry CO-181, which marks a code that was invalid on the date of service. Checking rejections against common denial codes helps billers spot that pattern quickly.

CMS publishes additions and deletions in the CMS quarterly HCPCS update files. Checking them each quarter catches the next deleted S-code before it reaches a claim.

How claims management software keeps drug codes current

In many practices, the drug code sits in a charge master that staff rarely open between annual code releases. When S0080 was deleted, that list kept printing it until denials arrived.

Practice management software like Pabau stores the code and default quantity on each treatment and drug line. Update pentamidine once to J2516 at 1 mg per unit, and every new invoice picks it up. Pabau’s built-in claims management then sends the claim and tracks the payer response in the patient record.

The result is fewer invalid-code rejections after each annual release. When a denial does arrive, the charge, the code, and the payer response sit in one place.

Keep deleted drug codes off your claims

Pabau stores the code and unit on each drug line, raises the invoice against the patient’s insurer, and tracks what comes back. One update covers every future charge.

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Conclusion

S0080 is now a historical code, but it still decides how 2025 pentamidine claims are corrected and appealed. For any dose given from January 1, 2026, the answer is J2516.

The code swap is the easy part. The unit change from 300 mg to 1 mg is what turns a routine claim into an underpayment. Fix the default quantity at the same time.

Book a demo to see how Pabau keeps drug codes and units current on every claim you send.

Continue your research

Billing the inhaled form of the same drug? HCPCS code J2545 covers non-compounded pentamidine inhalation solution given through DME.

Working with a compounded inhalation product? HCPCS code J7676 explains how compounded pentamidine is billed.

Billing another non-Medicare drug code? HCPCS code S0081 covers piperacillin sodium injection and the S-code versus J-code decision.

Seeing invalid-code rejections after January 1? Denial management in healthcare covers how to group denials by cause and work them down.

Want fewer rejections on drug claims? Submitting a clean claim covers the formatting and documentation that prevent common rejections.

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