J0799 — Fda approved prescription drug, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv), not otherwise classified
J0799 is a 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. 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 J0799
- Long descriptor
- 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
- Added
- January 2, 2024
- BETOS
- O1E
- Pricing indicator
- 46 — DMEPOS
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.
Carrier priced — not otherwise classified, individual determination, carrier discretion, or gap-filled amounts.
Codes adjacent to J0799
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J0799 is not quite right, the correct code is very often within a few positions of it.
- J0752Oral, lenacapavir, 300 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for 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
- J0800Injection, corticotropin, up to 40 unitsterminated
- J0801Injection, corticotropin (acthar gel), up to 40 units
- J0802Injection, corticotropin (ani), up to 40 units
- J0833Injection, cosyntropin, not otherwise specified, 0.25 mgterminated
- J0834Injection, cosyntropin, 0.25 mg
- J0840Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram
- J0841Injection, crotalidae immune f(ab')2 (equine), 120 mg
- J0850Injection, cytomegalovirus immune globulin intravenous (human), per vial
Questions about J0799
What is HCPCS code J0799?
J0799 is a 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. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J0799?
The CMS HCPCS file marks J0799 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 J0799 paid under the physician fee schedule?
J0799 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.