Home › Drug Codes › J Codes › J1961 · SUNLENCA
Updated October 1st, 2026

SUNLENCA J Code: J1961

Injection, lenacapavir (only for use as hiv treatment), 1 mg

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Medicare Payment Limit ?
$22.937
/ HCPCS billing unit
APC Payment Limit ?
$22.937
/ HCPCS billing unit · APC 9155
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
2
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Drug & Product Overview

HCPCS Descriptor Injection, lenacapavir (only for use as hiv treatment), 1 mg
HCPCS Added Date July 1, 2023
Manufacturer Gilead Sciences
Route of Administration Subcutaneous
Generic Status Single-Source; Branded
Dosage Type Single-Dose
Dosage Form Kit

About SUNLENCA

Sunlenca is a medication aligned to the HCPCS J Code: J1961 for billing, pricing, and reimbursement purposes in the United States. Classified under Misc., it is administered via the subcutaneous route and manufactured by Gilead Sciences.

According to CMS Drug Use Information: Lenacapavir is used with other HIV medications to help control HIV infection. It helps to decrease the amount of HIV in your body so your immune system can work better. This lowers your chance of getting HIV complications (such as new infections, cancer) and improves your quality of life. Lenacapavir belongs to a class of drugs known as capsid inhibitors. It blocks the virus from growing and infecting more cells. This medication is also used to help prevent HIV infection in people who have a high risk for infection. Some things that increase risk include having a partner infected with HIV, having unprotected sex, having multiple sex partners, infection with a sexually transmitted disease-STD, or use/abuse of drugs or alcohol. Lenacapavir is not a cure for HIV infection. To decrease your risk of spreading HIV disease to others, continue to take all HIV medications exactly as prescribed by your doctor. 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. There are 2 different brands used for treatment and prevention of HIV. Do not switch brands of lenacapavir without checking with your doctor.

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

Based on publicly available CMS files. The list of NDCs below is not exhaustive.

NDC Code Drug Manufacturer Billing Units / Pkg Package Size
61958-3002-01 Sunlenca Gilead Sciences, Inc. 927 Kit
61958-3005-01 Sunlenca Gilead Sciences, Inc. 927 Kit
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SUNLENCA Pricing & Reimbursement

J1961 Private Payer Reimbursement
$22.29 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna

Historical Graphing and Billing Calculator

per HCPCS unit
As of Q4 2026

SUNLENCA Claims Performance

Claims from Jan 2026 – Aug 2026
Claim Denial Rate 0%
Avg. Days to File 3.0days
Avg. Days to Pay 0.0days

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

Explore J1961 claims analytics on FocalPoint →
OnPoint Oncology

SUNLENCA 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 Sunlenca (J1961) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J1961. Wastage billing guide →

SUNLENCA 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 infection

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Frequently Asked Questions

Is there an available Sunlenca billing and coding guide?
Billing and coding information for SUNLENCA can be found through GILEAD SCIENCES, INC.. Visit Here →
Are there any available Sunlenca patient assistance programs?
SUNLENCA patient assistance information can be found through GILEAD SCIENCES, INC.. Visit Here →
Where can I find Sunlenca prescribing information?
SUNLENCA prescribing information can be found at the link below: Visit Here →
Where can I find Sunlenca side effect information?
Information regarding SUNLENCA's side effects can be found at MedlinePlus Visit Here →
Does billing SUNLENCA require JZ/JW wastage modifiers?
CMS does not include SUNLENCA (J1961) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J1961. For more information, visit the link below.

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