J1961 HCPCS code: Injection, lenacapavir (only for use as hiv treatment), 1 mg
J1961 is the HCPCS Level II code for injection, lenacapavir (only for use as hiv treatment), 1 mg. In 2024 Medicare paid an average of $9.28 per service for J1961 across 8,041 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. In 2024, about 14 clinicians billed Medicare for J1961 for 13 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2023-07-01 |
| Last action effective | 2025-06-18 |
Who bills J1961 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 14 |
| Medicare beneficiaries | 13 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1961, 2024–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2024 | 8,041 | 13 | $11.66 | $9.28 |
What changed for J1961
- October 2025: Descriptor revised (Was: Injection, lenacapavir, 1 mg)
- 2025-06-18: Last CMS action: long description changed
- 2023-07-01: J1961 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 J1961?
J1961 is the HCPCS Level II code for injection, lenacapavir (only for use as hiv treatment), 1 mg. Short descriptor: "Inj lenacapavir (hiv tx) 1mg".
How much does Medicare pay for J1961?
In 2024, the average Medicare payment was $9.28 per service (average allowed $11.66).
Does Medicare cover J1961?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related J19 codes
- J1920 — Injection, labetalol hydrochloride, 5 mg
- J1921 — Injection, labetalol hydrochloride (hikma), not therapeutically equivalent to j1920, 5 mg
- J1930 — Injection, lanreotide, 1 mg
- J1931 — Injection, laronidase, 0.1 mg
- J1932 — Injection, lanreotide, (cipla), 1 mg
- J1938 — Injection, furosemide, 1 mg
- J1939 — Injection, bumetanide, 0.5 mg
- J1940 — Injection, furosemide, up to 20 mg
- J1941 — Injection, furosemide (furoscix), 20 mg
- J1942 — Injection, aripiprazole lauroxil, 1 mg
- J1943 — Injection, aripiprazole lauroxil, (aristada initio), 1 mg
- J1944 — Injection, aripiprazole lauroxil, (aristada), 1 mg
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 J1961
- Watch J1961 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1961
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.