Summary & Overview
HCPCS Level II J0750: Emtricitabine-Tenofovir for HIV Pre-Exposure Prophylaxis
HCPCS Level II code J0750 denotes the combination oral antiretroviral medication emtricitabine 200 mg with tenofovir disoproxil fumarate 300 mg when prescribed solely for HIV pre-exposure prophylaxis (PrEP). This code is significant nationally as PrEP is a cornerstone of HIV prevention strategies and influences pharmacy benefit design, access programs, and public health initiatives. Coverage and utilization of J0750 affect prevention outcomes and payer pharmacy spending across commercial and public plans.
Key payers in scope for national comparisons include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses coverage policies, common site-of-service patterns (primarily outpatient and retail pharmacy dispensing), and typical billing practice for this prescription product.
Readers will learn the clinical context of the medication as a PrEP agent, how J0750 is used in billing workflows, common modifiers and claims considerations when available, and what to expect in payer interactions and pharmacy settings. The report summarizes benchmarks and policy-relevant issues affecting access and reimbursement for this PrEP product. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code J0750 represents a single-entity oral antiretroviral medication: emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg, FDA-approved only for HIV pre-exposure prophylaxis (PrEP) and not for treatment of HIV. The code denotes the medication product furnished under a prescription for PrEP.
Service type: Prescription medication for HIV pre-exposure prophylaxis (PrEP).
Typical site of service: Outpatient retail or specialty pharmacy dispensing; may also be administered via clinic- or health-system-based pharmacy programs providing PrEP prescriptions for at-risk individuals.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an HIV-negative adult seeking HIV pre-exposure prophylaxis (PrEP) after a documented potential exposure risk (e.g., partner with HIV, sexual exposure, or injection drug use). The clinical workflow begins with a preventive medicine or infectious disease visit where the provider documents risk assessment, obtains baseline laboratory tests (HIV antigen/antibody, renal function — serum creatinine, hepatitis B surface antigen, pregnancy test if applicable, and STI screening), counsels on adherence and safer-sex practices, and prescribes the FDA-approved PrEP oral medication combination J0750 (emtricitabine 200 mg / tenofovir disoproxil fumarate 300 mg). Medication is dispensed or provided per facility policy; follow-up visits are scheduled at approximately 1 month after initiation and every 3 months thereafter for repeat HIV testing, renal monitoring, and STI screening. Typical sites of service include outpatient primary care clinics, sexually transmitted infection clinics, specialty infectious disease or HIV prevention clinics, and community-based health centers. The typical patient scenario includes documentation of negative baseline HIV test, documented indication for PrEP, patient education, and a written prescription or medication provision coded with J0750 when the drug is billed under HCPCS Level II (for example, when supplied by a clinic or covered under medical benefit).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |