J0752 — Oral, lenacapavir, 300 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
J0752 is a HCPCS Level II code for oral, lenacapavir, 300 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 J0752
- Long descriptor
- Oral, lenacapavir, 300 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
- Short descriptor
- Hiv prep, oral 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 J0752
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J0752 is not quite right, the correct code is very often within a few positions of it.
- 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)
- J0751Emtricitabine 200mg and tenofovir alafenamide 25mg, oral, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv)
- J0759Injection, clevidipine butyrate, 1 mg
- J0760Injection, colchicine, per 1 mgterminated
- J0770Injection, colistimethate sodium, up to 150 mg
- J0775Injection, collagenase, clostridium histolyticum, 0.01 mg
- J0780Injection, prochlorperazine, up to 10 mg
- J0791Injection, crizanlizumab-tmca, 5 mg
- J0795Injection, corticorelin ovine triflutate, 1 microgramterminated
- J0799Fda approved prescription drug, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv), not otherwise classified
Questions about J0752
What is HCPCS code J0752?
J0752 is a HCPCS Level II code for oral, lenacapavir, 300 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 J0752?
The CMS HCPCS file marks J0752 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 J0752 paid under the physician fee schedule?
J0752 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.