J1961
J1961 – Injection, lenacapavir, 1 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 3 NDCs crosswalked per 1 MG $22.936/unit ASP+6%
📋 J1961 summary
J1961 is a HCPCS Level II J-code used to bill lenacapavir, 1 mg, 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 J1961: Sunlenca, Yeztugo
Code J1961
Billing unit 1 MG Payment limit $22.936/unit NDC-Crosswalk 3
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 codeJ1961
DescriptorInjection, lenacapavir, 1 mg
Billing unit1 MG
Payment limit / unit$22.936
Est. ASP / unit$21.638 est.
Mapped NDCs3
Data periodQ3 2026
Last updated2026-08-20
💊 About Lenacapavir Oral DRUG GUIDE
Sunlenca tablets are used in two situations: to treat HIV-1 infection in adults whose virus has become resistant to multiple antiretroviral drugs and whose current regimen is failing — always in combination with other antiretrovirals — and as a short oral loading dose to start the BIXLENVO complete HIV-1 treatment regimen in adults who are already virologically suppressed (virus undetectable) and switching from a stable antiretroviral regimen.Yeztugo tablets are used as part of HIV-1 pre-exposure prophylaxis (PrEP) — helping HIV-negative people reduce their risk of getting HIV-1.
The oral tablet form is used during initiation of Yeztugo, and also as a temporary oral bridge if a scheduled injection must be delayed more than two weeks.
Clinical overview from our editorial drug guide for Lenacapavir Oral. 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
$22.936
Est. ASP / unit
$21.638 est.
Est. after 2% sequester
$22.477
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, lenacapavir, 1 mg
CoverageC — Carrier/MAC judgment
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment groupYY
Action codeN — No maintenance this year
Effective date2023-07-01
Date added2023-07-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J1961 = 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 J1961 WITH EST. MEDICARE PAY
3 NDCs map to J1961. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($22.936/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 61958-3002-01 | Sunlenca LENACAPAVIR SODIUM KIT | Gilead | 1 KIT in 1 CARTON (61958-3002-1) * 1.5 m... | — | 927 | $21,261.67 | — | ● Active | CMS + PDAC |
| 61958-3005-01 | Sunlenca LENACAPAVIR SODIUM KIT | Gilead | 1 KIT in 1 CARTON (61958-3005-1) * 1.5 m... | — | 927 | $21,261.67 | — | ● Active | CMS + PDAC |
| 61958-3402-01 | Yeztugo LENACAPAVIR SODIUM KIT | Gilead | 1 KIT in 1 CARTON (61958-3402-1) * 1.5 m... | — | 309 | $7,087.22 | — | ● 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
$395.8K
Claims
26
Beneficiaries
26
Spend / beneficiary
$15,223.41
Spend / claim
$15,223.41
Trend by period
Where J1961 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #463 of 824
#458
ARISTADA J1944
$412.6K
#459
DEXAMETHASONE SODIUM... J1100
$404.4K
#460
LYUMJEV J1813
$402.9K
#461
MEMBRANE WRAP HYDR P... Q4290
$401.6K
#462
FULVESTRANT J9394
$400K
#463
SUNLENCA J1961
$395.8K
#464
YEZTUGO(J0752) J0752
$395.7K
#465
RISPERDAL CONSTA* J2794
$388.4K
#466
ALLOPLY, PER SQ CM** Q4323
$387.1K
#467
DOCETAXEL J9171
$375.5K
#468
CARBOPLATIN* J9045
$364K
Total claims — #759 of 824
#754
MORPHINE SULFATE(J22... J2272
27
#755
FIBRYGA J7177
27
#756
REVITA, PER SQ CM** Q4180
27
#757
ACTIVATE MATRIX, PER... Q4301
27
#758
HEPARIN SODIUM J1643
26
#759
SUNLENCA J1961
26
#760
EVOMELA J9246
26
#761
AFLURIA (90657)* 90657
25
#762
TROGARZO J1746
25
#763
ALDURAZYME J1931
25
#764
ESPEROCT J7204
25
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) | $395.8K | 26 | 26 | $15,223.41 | $15,223.41 |
| 2025 (Q1-Q4) | $1.17M | 75 | 101 | $15,575.36 | $11,565.86 |
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
$207.7K
Medicare paid
$162.7K
Submitted services
26,156
Denial rate
21.3%
Allowed / service
$10.09
Submitted charges
$600K
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.
🗺️ Where J1961 is utilized
⏳
The geographic utilization map is building for this code — it aggregates millions of CMS Part B claim lines, then caches the result. Refresh in a moment; if it doesn’t appear, this code may have no reportable Part B utilization.
📊 What bills under J1961
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)
3 NDCs 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.
❓ J1961 billing FAQ
What is HCPCS code J1961?
J1961 is a HCPCS Level II J-code used to bill Injection, lenacapavir, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J1961?
One unit of J1961 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of J1961 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 J1961?
The Medicare Part B payment limit is $22.936 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $22.477 per unit. Payment limits are revised quarterly.
Which NDCs bill under J1961?
3 NDCs currently map to J1961 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 J1961 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.