J0738 HCPCS code: Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
J0738 is the HCPCS Level II code for injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv). Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 57 |
| BETOS category | O1E — Other drugs |
| Added | 2025-10-01 |
| Last action effective | 2025-10-01 |
What changed for J0738
- October 2025: Code appears in this HCPCS release
- 2025-10-01: J0738 added to HCPCS Level II
- 2025-10-01: Last CMS action: code added
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J0738?
J0738 is the HCPCS Level II code for injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv). Short descriptor: "Hiv prep, inj, lenacapavir".
Does Medicare cover J0738?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Related J07 codes
- J0701 — Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500 mg
- J0702 — Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg
- J0703 — Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500 mg
- J0706 — Injection, caffeine citrate, 5 mg
- J0710 — Injection, cephapirin sodium, up to 1 gm
- J0712 — Injection, ceftaroline fosamil, 10 mg
- J0713 — Injection, ceftazidime, per 500 mg
- J0714 — Injection, ceftazidime and avibactam, 0.5 g/0.125 g
- J0715 — Injection, ceftizoxime sodium, per 500 mg
- J0716 — Injection, centruroides immune f(ab)2, up to 120 milligrams
- J0717 — Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
- J0720 — Injection, chloramphenicol sodium succinate, up to 1 gm
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Next steps
- Run a reimbursement report for a device billed under J0738
- Watch J0738 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0738
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.