J0738 Hiv prep, injection, lenacapavir
Also known as: lenacapavir, Apretude, capsid inhibitor
Lenacapavir injection for HIV pre-exposure prophylaxis (PrEP), a long-acting capsid assembly inhibitor given twice yearly.
In Plain Language
HIV prevention shot; twice-yearly preventive injection
Clinical Context
Novel long-acting HIV preexposure prophylaxis given as intravenous bolus loading doses followed by maintenance injections every 6 months. Highly effective for prevention of HIV infection.
RVU Information
CPT J0738 does not have a physician work RVU assigned by CMS. This is typical for supply, drug, and equipment codes — reimbursement is based on Average Sales Price (ASP), fee schedules, or payer contracts rather than the RVU system.
Billing & Documentation
J-codes represent drugs administered by a healthcare provider (not self-administered). Documentation must include the drug name, dosage, route of administration, and medical necessity. Most payers require the National Drug Code (NDC) on the claim. Bill the appropriate administration code (96365-96379) in addition to the drug code.
Specialties
Frequently Asked Questions
What is CPT code J0738?
CPT J0738 (Hiv prep, injection, lenacapavir) is a J Codes (Drugs) code. Lenacapavir injection for HIV pre-exposure prophylaxis (PrEP), a long-acting capsid assembly inhibitor given twice yearly.
How is J0738 administered?
CPT J0738 is administered by a healthcare provider, typically via injection or infusion. Novel long-acting HIV preexposure prophylaxis given as intravenous bolus loading doses followed by maintenance injections every 6 months. Highly effective for prevention of HIV infection. It is used by infectious disease, preventive medicine, internal medicine.
When is CPT J0738 used?
Novel long-acting HIV preexposure prophylaxis given as intravenous bolus loading doses followed by maintenance injections every 6 months. Highly effective for prevention of HIV infection.
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CPT® is a registered trademark of the American Medical Association. Data sourced from CMS Physician Fee Schedule RVU26A. Descriptions, synonyms, and clinical context are original content by RVU Edge.