J0739
J0739 – Injection, cabotegravir, 1mg, fda approved prescription, only for use as · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 1 NDC crosswalked per 1 mg $7.294/unit ASP+6%
📋 J0739 summary
J0739 is a HCPCS Level II J-code used to bill cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis..., billed per 1 mg. The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.
Brand names associated with J0739: Apretude
Code J0739
Billing unit 1 mg Payment limit $7.294/unit NDC-Crosswalk 1
Quarter Q3 2026
RxCUI Atlas Trace the drug concept →
⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.
🗂️ Key billing facts
HCPCS codeJ0739
DescriptorInjection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
Billing unit1 mg
Payment limit / unit$7.294
Est. ASP / unit$6.881 est.
Mapped NDCs1
Data periodQ3 2026
Last updated2026-08-20
💊 About Cabotegravir DRUG GUIDE
Vocabria (cabotegravir) tablets are used in combination with rilpivirine (Edurant) to treat HIV-1 infection in adults and adolescents aged 12 and older who weigh at least 35 kg and whose HIV is already virologically suppressed (virus levels undetectable or very low on their current regimen).
Vocabria tablets serve as a short-term oral lead-in — taken for roughly one month — before switching to long-acting injectable therapy.Cabotegravir tablets are also used as an oral lead-in for HIV-1 pre-exposure prophylaxis (PrEP) — helping HIV-negative adults and adolescents (weighing at least 35 kg) confirm they tolerate the drug before starting injectable PrEP.
Both uses require confirmed HIV-negative status before starting.
Clinical overview from our editorial drug guide for Cabotegravir. For billing reference, see the sections above.
🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026
📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$7.294
Est. ASP / unit
$6.881 est.
Est. after 2% sequester
$7.148
HCPCS dosage
1 mg
The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly), Q3 2026.
Full HCPCS code details (official CMS record)
Long descriptionInjection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
CoverageD — Special coverage instructions apply
Pricing indicator57
Type of service1 — Medical care
BETOS-2O1E
ASC payment group—
Action codeB
Effective date2024-01-02
Date added2022-07-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J0739 = 1 mg. Enter a regimen to convert dose → billing units and project a full course.
Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.
🔁 NDCs that bill under J0739 WITH EST. MEDICARE PAY
1 NDC map to J0739. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($7.294/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 49702-0264-23 | Apretude Cabotegravir KIT | ViiV | 1 KIT in 1 CARTON (49702-264-23) * 3 mL... | — | 200 | $1,458.80 | — | ● Active | PDAC |
NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.
📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)
Period
Total Part B spend
$3.76M
Claims
959
Beneficiaries
622
Spend / beneficiary
$6,040.19
Spend / claim
$3,917.62
Trend by period
Where J0739 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #266 of 824
#261
AXTLE J9292
$4.01M
#262
TRELSTAR J3315
$3.85M
#263
RIABNI Q5123
$3.85M
#264
FORMOTEROL FUMARATE* J7606
$3.83M
#265
FOCINVEZ J1434
$3.77M
#266
APRETUDE J0739
$3.76M
#267
ELOCTATE J7205
$3.72M
#268
IODIXANOL(Q9967)* Q9967
$3.58M
#269
BACLOFEN(J0475)* J0475
$3.51M
#270
ALBUKED-25(P9047)* P9047
$3.5M
#271
ACTIVASE* J2997
$3.49M
Total claims — #378 of 824
#373
KIMMTRAK J9274
997
#374
PROCHLORPERAZINE EDI... J0780
996
#375
TEPEZZA J3241
985
#376
POTELIGEO J9204
976
#377
LANREOTIDE ACETATE(J... J1932
970
#378
APRETUDE J0739
959
#379
OASIS ULTRA Q4124
939
#380
BLINCYTO J9039
933
#381
MANNITOL(J2151) J2151
925
#382
BEOVU J0179
920
#383
CABENUVA J0741
920
Top Medicare Part B drugs by the selected metric. Click any drug to open its J-code page. Source: CMS Medicare Quarterly Part B Spending by Drug.
Full breakdown by period (2)
| Period | Total spend | Beneficiaries | Claims | $/beneficiary | $/claim |
|---|---|---|---|---|---|
| 2026 (Q1) | $3.76M | 622 | 959 | $6,040.19 | $3,917.62 |
| 2025 (Q1-Q4) | $13.3M | 858 | 3,683 | $15,498.20 | $3,610.49 |
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.
📈 Medicare Part B claims detail CMS PSPS · 2024
Calendar-year 2024 Medicare Part B fee-for-service activity for this HCPCS code, summed across all carriers, localities and specialties (CMS Physician/Supplier Procedure Summary). A “service” is one billed line/unit — not one claim — so counts run higher than claim counts.
Allowed charges
$12.46M
Medicare paid
$12.19M
Submitted services
2,086,704
Denial rate
11.7%
Allowed / service
$6.77
Submitted charges
$19.7M
Source: CMS Physician/Supplier Procedure Summary (PSPS), CY2024 — Medicare Part B carrier + DME fee-for-service claims (excludes Medicare Advantage). Figures are for the whole HCPCS code, which may cover uses beyond this drug. ⚠ CMS hides any figure covering fewer than 11 patients (a privacy rule), so totals — especially denials and low-volume codes — run a little low.
📊 What bills under J0739
J-codes are billing codes often used for drugs billed under the medical benefit. This connects the billing code to the NDC package records it covers, by ingredient and labeler.
NDC products by ingredient
NDC products by labeler
🗃️ Data sources & freshness
Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.
HCPCS code & descriptor
CMS HCPCS Level II code file
Loaded
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Q3 2026 · as of 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk + DMEPDAC (PDAC)
1 NDC mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
Not available for mapped NDCs
Utilization & spend
CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners
Latest data year 2026
Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.
⚠️ Practical billing caveats
- A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
- Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
- Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
- Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
- The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
- Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.
❓ J0739 billing FAQ
What is HCPCS code J0739?
J0739 is a HCPCS Level II J-code used to bill Injection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv) under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J0739?
One unit of J0739 represents 1 mg. Report the number of units equal to the dose administered divided by 1 mg.
How many units of J0739 should I bill?
Divide the dose administered by the code's unit size (1 mg) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for J0739?
The Medicare Part B payment limit is $7.294 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $7.148 per unit. Payment limits are revised quarterly.
Which NDCs bill under J0739?
1 NDC currently map to J0739 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.
Does a crosswalk mean J0739 is covered?
No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.
For professional billing reference only — verify against the current CMS files before submitting claims.