J0739 HCPCS code: Injection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
J0739 is the HCPCS Level II code for injection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv). In 2024 Medicare paid an average of $4.45 per service for J0739 across 79,445 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 600 per day on outpatient hospital claims. In 2024, 95 suppliers billed Medicare for J0739 (purchases), serving 214 beneficiaries; California, New York, Pennsylvania accounted for 74% of services.
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 | 2022-07-01 |
| Last action effective | 2025-01-02 |
Who bills J0739 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 95 |
| Referring clinicians | 165 |
| Medicare beneficiaries | 214 |
| States with claims | 7 |
| Share of services in top 3 states (California, New York, Pennsylvania) | 74% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0739, 2024–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2024 | 79,445 | 88 | $5.00 | $4.45 |
States with the most J0739 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 15,600 | $4.52 |
| California | 15,226 | $4.62 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 600 | Prescribing Information |
| practitioner claims | 600 | Prescribing Information |
What changed for J0739
- 2022-07-01: J0739 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J0739?
J0739 is the HCPCS Level II code for injection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv). Short descriptor: "Hiv prep, inj, cabotegravir".
How much does Medicare pay for J0739?
In 2024, the average Medicare payment was $4.45 per service (average allowed $5.00).
Does Medicare cover J0739?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J0739 can be billed per day?
600 on outpatient hospital claims; 600 on practitioner claims (NCCI medically unlikely edits).
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 J0739
- Watch J0739 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0739
Sources: CMS HCPCS Level II release October 2026; 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.