HCPCS Code J0739: Injection of Cabotegravir, Specifically 1mg, for HIV Pre Exposure Prophylaxis (PrEP)

Yes. Medicare covers cabotegravir when prescribed for HIV pre-exposure prophylaxis (PrEP) under its expanded coverage policy. HCPCS code J0739 is primarily indicated and covered for HIV pre-exposure prophylaxis (PrEP) in at-risk HIV-negative individuals. While cabotegravir extended-release injectable formulations are FDA-approved as part of HIV treatment regimens for people living with HIV, J0739 is generally not used or covered for treatment purposes under most payer policies. Coverage and coding for treatment with cabotegravir typically use a different HCPCS code (e.g., J0741 for cabotegravir and rilpivirine combination). Providers should verify payer-specific policies to determine appropriate code use and coverage for treatment indications.

Yes. J0739 only represents the drug. Providers must also bill the appropriate CPT injection administration code (e.g., 96372) to capture the service of administering the medication.

It is billed per 1 mg of cabotegravir. Since injections are typically given in larger doses, the total units reported should reflect the exact milligrams administered to the patient.