J0738 HCPCS Level II code: Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
J0738 is the HCPCS code for “Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)” in CMS’s October 2026 release, in effect from Oct 1, 2026.
Official description
J0738Injection, 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
HCPCS · United States
Medicare details
The indicators CMS publishes with J0738 in its October 2026 file. They describe Medicare’s handling, not another payer’s.
- Medicare coverage
- Special coverage instructions apply
- Medicare pricing
- Other carrier priced
- ASC
- Approved for ambulatory surgical centers
- Type of service
- Medical care; Lump sum purchase of DME, prosthetics, orthotics
- BETOS category
- Other drugs
- Coverage statute
- 1861 ddd
- Added
- Oct 1, 2025
Where J0738 sits
- 1J codesDrugs administered other than orally
- 2Active code J0738Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
Source and release
- Data release
- HCPCS Level II · October 2026
- Effective date
- Oct 1, 2026
- Publisher
- CMS
This page is built from the HCPCS Level II catalog that Vero Codes reads when it suggests codes: Centers for Medicare & Medicaid Services’s October 2026 release, imported from the publisher’s file and checked against it. The description, notes and structured data come from the same record.
Frequently asked questions
What does HCPCS code J0738 mean?
J0738 is the HCPCS code for “Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)” in CMS’s HCPCS Level II October 2026 release.
Does Medicare cover J0738?
CMS lists J0738’s Medicare coverage as “Special coverage instructions apply” and its pricing as “Other carrier priced”. Coverage and payment still depend on the patient, the setting, the documentation and the payer.
Which HCPCS Level II release does this page use?
It uses CMS’s October 2026 release, in effect from Oct 1, 2026 to Dec 31, 2026. It is a reference: confirm the code against the current list and the payer’s rules before you submit it.
Codes beside J0738
All J codesJ0717Injection, 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 gmJ0725Injection, chorionic gonadotropin, per 1,000 usp unitsJ0735Injection, clonidine hydrochloride, 1 mgJ0736Injection, clindamycin phosphate, 300 mgJ0737Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mgJ0739Injection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)J0740Injection, cidofovir, 375 mgJ0741Injection, cabotegravir and rilpivirine, 2mg/3mgJ0742Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mgJ0743Injection, cilastatin sodium; imipenem, per 250 mgJ0744Injection, ciprofloxacin for intravenous infusion, 200 mg