J0738 — Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
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). It belongs to the Drugs Administered Other Than Oral Method section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for J0738
- Long descriptor
- 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
- Added
- October 1, 2025
- BETOS
- O1E
- Pricing indicator
- 57 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Other carrier priced.
Codes adjacent to J0738
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J0738 is not quite right, the correct code is very often within a few positions of it.
- J0715Injection, ceftizoxime sodium, per 500 mgterminated
- J0716Injection, centruroides immune f(ab)2, up to 120 milligrams
- J0717Injection, 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)
- J0720Injection, chloramphenicol sodium succinate, up to 1 gm
- J0725Injection, chorionic gonadotropin, per 1,000 usp units
- J0735Injection, clonidine hydrochloride, 1 mg
- J0736Injection, clindamycin phosphate, 300 mg
- J0737Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg
- J0739Injection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
- J0740Injection, cidofovir, 375 mg
- J0741Injection, cabotegravir and rilpivirine, 2mg/3mg
- J0742Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mg
- J0743Injection, cilastatin sodium; imipenem, per 250 mg
- J0744Injection, ciprofloxacin for intravenous infusion, 200 mg
- J0745Injection, codeine phosphate, per 30 mg
- J0750Emtricitabine 200mg and tenofovir disoproxil fumarate 300mg, oral, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv)
Questions about J0738
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). It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J0738?
The CMS HCPCS file marks J0738 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is J0738 paid under the physician fee schedule?
J0738 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.