Home Drug Codes J Codes J0738 · YEZTUGO
Updated July 1st, 2026

YEZTUGO J Code: J0738

Injection, lenacapavir, 1 mg, 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 J0738, effective October 1, 2026: $16.016 per HCPCS billing unit, down 0.4% from $16.081. From CMS's final file.

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Medicare Payment Limit ?
$16.081
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$16.081
/ HCPCS billing unit · APC 0880
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
1
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Drug & Product Overview

HCPCS Descriptor Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
HCPCS Added Date October 1, 2025
Manufacturer Gilead Sciences, Inc
Route of Administration Subcutaneous
Generic Status Single-Source; Branded
Dosage Form Kit

About YEZTUGO

Yeztugo is a medication aligned to the HCPCS J Code: J0738 for billing, pricing, and reimbursement purposes in the United States. This Anti-HIV medication is administered via the subcutaneous route and manufactured by Gilead Sciences, Inc.

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

1 NDC package is crosswalked to J0738. Package detail is available to logged-in subscribers.

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YEZTUGO Pricing & Reimbursement

J0738 Private Payer Reimbursement
$16.10 / 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 Q3 2026

YEZTUGO 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

This product is new and does not yet appear on the CMS list of HCPCS pertaining to single-dose containers. Wastage billing guide →

YEZTUGO 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 Yeztugo billing and coding guide?
Billing and coding information for YEZTUGO can be found through Gilead Sciences INC.. Visit Here →
Are there any available Yeztugo patient assistance programs?
YEZTUGO patient assistance information can be found through Gilead Sciences INC.. Visit Here →
Where can I find Yeztugo prescribing information?
Yeztugo prescribing information can be found through the link below. Visit Here →
Where can I find Yeztugo side effect information?
Yeztugo side effect information can be found at the link below. Visit Here →
Does billing Yeztugo require wastage modifiers?
CMS does not include YEZTUGO (J0738) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J0738. For more information, visit the link below.

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