J0799 HCPCS code: Fda approved prescription drug, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv), not otherwise classified
J0799 is the HCPCS Level II code for fda approved prescription drug, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv), not otherwise classified. 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 | 46 — Priced by the Medicare contractor (no national fee) |
| BETOS category | O1E — Other drugs |
| Added | 2024-01-02 |
| Last action effective | 2024-01-02 |
What changed for J0799
- 2024-01-02: J0799 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 J0799?
J0799 is the HCPCS Level II code for fda approved prescription drug, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv), not otherwise classified. Short descriptor: "Hiv prep, fda approved, noc".
Does Medicare cover J0799?
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
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J0799
- Watch J0799 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0799
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.