J0738 – Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)

HCPCS Level II code · J codes: Drugs Administered Other Than Oral Method

Active code Special coverage instructions apply

HCPCS codeJ0738
Long description
Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
Short description
Hiv prep, inj, lenacapavir
Pricing indicator
57 Other carrier priced
Medicare coverage
D Special coverage instructions apply
BETOS category
O1E Other drugs
ASC
Approved for ambulatory surgical centers
Added
October 1, 2025
Last change
October 1, 2025 – No change

Frequently asked questions

What is HCPCS code J0738?

J0738 is a 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).

Does Medicare cover J0738?

The HCPCS file lists coverage code D: Special coverage instructions apply. Coverage and payment also depend on local coverage determinations and the patient’s plan.

Nearby J codes

Source: CMS HCPCS Level II quarterly file, October 2026. Reference only – check payer policy before billing.