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Updated July 1st, 2026

APRETUDE J Code: J0739

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

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Q4 2026 Medicare Payment Limit for J0739, effective October 1, 2026: $7.278 per HCPCS billing unit, down 0.2% from $7.294. From CMS's final file.

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Medicare Payment Limit ?
$7.294
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$7.294
/ HCPCS billing unit · APC 0805
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
1
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Drug & Product Overview

HCPCS Descriptor Injection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
HCPCS Added Date July 1, 2022
Manufacturer ViiV
Route of Administration Intramuscular
Generic Status Single-Source; Branded
Dosage Type Single-Dose
Dosage Form Kit

About APRETUDE

Apretude is a medication aligned to the HCPCS J Code: J0739 for billing, pricing, and reimbursement purposes in the United States. It is an Anti-HIV drug administered via the intramuscular route and manufactured by ViiV.

According to CMS Drug Use Information: This product is used to help reduce the risk of getting HIV infection. Cabotegravir belongs to a class of drugs known as integrase inhibitors. It works by blocking the virus from growing and infecting more cells. This product does not protect against other sexually transmitted infections (such as gonorrhea, syphilis). When cabotegravir is given in combination with rilpivirine, it is used to help control HIV infection. To decrease your risk of getting HIV and other sexually transmitted infections, use an effective barrier method (latex or polyurethane condoms/dental dams) during sexual activity as directed by your doctor. Do not share personal items (such as needles/syringes, toothbrushes, and razors) that may have contacted blood or other body fluids. Consult your doctor or pharmacist for more details.

Disclaimer: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your healthcare professional.

NDC Code Information

1 NDC package is crosswalked to J0739. Package detail is available to logged-in subscribers.

NDC Code Drug Manufacturer Billing Units / Pkg Package Size
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APRETUDE Pricing & Reimbursement

J0739 Private Payer Reimbursement
$7.11 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

Create an account on PayerPrice for more information →
UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna

Historical Graphing and Billing Calculator

per HCPCS unit
As of Q3 2026

APRETUDE Claims Performance

Claims from Jan 2026 – Aug 2026
Claim Denial Rate 29.46%
Avg. Days to File 17.4days
Avg. Days to Pay 26.2days

Real-world claims performance from FocalPoint, OnPoint Oncology's reimbursement analytics platform, with claims data accrued at the clearing house level.

Explore J0739 claims analytics on FocalPoint →
OnPoint Oncology

APRETUDE CPT Administration Codes

The below list of CPT codes is intended for informational purposes only and may not be exhaustive. CPT® codes and descriptions are copyright American Medical Association (AMA). All rights reserved.

CPT Code Description
96372 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intramuscular
Not on the CMS JW / JZ list

CMS does not include Apretude (J0739) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J0739. Wastage billing guide →

APRETUDE Medically Unlikely Edits (MUE)

The most billing units of J0739 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 mg.

Practitioner Office & Hospital Outpatient
600 units / day
= 600 mg per day

MAI 3 · Date of Service Edit: Clinical. Per-day limit based on clinical expectations; excess units are denied but may be appealed with documentation of medical necessity. See all MUE limits →

mg Enter a dose to see how many billing units it is and whether it is under the limit.

APRETUDE Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.

HIV-1 pre-exposure prophylaxis (PrEP)

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Frequently Asked Questions

Is there an available Apretude billing and coding guide?
Our team has not identified a manufacturer-published source of billing and coding information for APRETUDE.
Are there any available Apretude patient assistance programs?
APRETUDE patient assistance information can be found through ViiV. Visit Here →
Where can I find Apretude prescribing information?
APRETUDE prescribing information can be found at the link below: Visit Here →
Where can I find Apretude side effect information?
Information regarding APRETUDE's side effects can be found at MedlinePlus Visit Here →
Does billing APRETUDE require JZ/JW wastage modifiers?
CMS does not include APRETUDE (J0739) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J0739. For more information, visit the link below.

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