HCPCS Code Details - J0739

HCPCS Level II Code
Drugs administered other than oral method, chemotherapy drugs
HCPCS Code J0739
Description

Long description:
Injection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)

Short description:
Hiv prep, inj, cabotegravir

HCPCS Modifier1
HCPCS Pricing indicator 57 - Other carrier priced
Multiple pricing indicator A - Not applicable as HCPCS priced under one methodology
Statute number 1861(ddd)
Coverage code D - Special coverage instructions apply
ASC payment group code Effective Jan 01, 2025 - This procedure is approved to be performed in an ambulatory surgical center.
BETOS2 code O1E - Other drugs
HCPCS Action code N - No maintenance for this code
Type of service 1 - Medical care
Effective date Effective Jan 02, 2025
Date added Added Jul 01, 2022
HCPCS Coding Procedures

HCPCS Modifiers

In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters.

Example: E0260-NU - Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress
NU” identifies the hospital bed as new equipment

ASP Drug pricing - J0739

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
April 1, 2026 - June 30, 2026 1 mg 7.145 - - - - - -
January 1, 2026 - March 31, 2026 1 mg 7.147 - - - - - -
October 1, 2025 - December 31, 2025 1 mg 7.02 - - - - - -
Jul 1, 2025 - Sep 30, 2025 1 mg 7.033 - - - - - -
April 1, 2025 - June 30, 2025 1 mg 6.887 - - - - - -

See also

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

  • HCPCS J0740 · Injection, cidofovir, 375 mg


1 Two-digit numeric codes are Level I code modifiers copyrighted© by the American Medical Association's Current Procedural Terminology (CPT).

2 BETOS stands for “Berenson-Eggers Type Of Service”