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    v1.0.30
    OpenPayerBilling CodesDrugs Administered Other than Oral MethodHCPCS hcpcs-j0752-oral-lenacapavir-hiv-pre-exposure-prophylaxis-prEP
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    HCPCS Level II J0752: Oral lenacapavir 300 mg for HIV PrEP

    HCPCS Level II code J0752 describes an FDA‑approved oral formulation of lenacapavir supplied as 300 mg for use only as HIV pre-exposure prophylaxis (PrEP); service type is oral antiviral medication for HIV prevention and the typical site of service is outpatient pharmacy or clinic dispensing for PrEP administration.

    For related coverage guidance, see recent payer policy updates: T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and Romidepsin, Tumor Treatment Fields - Medical Policy, Extracorporeal Photopheresis.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an HIV-negative adult seeking HIV pre-exposure prophylaxis (PrEP) due to ongoing high-risk exposures (e.g., receptive or insertive anal or vaginal intercourse with partners of unknown or positive HIV status, condomless sex, or injection drug use). The patient presents to an outpatient sexual health clinic, primary care clinic, or specialty infectious disease practice. Clinical workflow: baseline evaluation includes HIV antigen/antibody testing, renal function (serum creatinine, eGFR), hepatitis B and C screening, pregnancy test if applicable, and STI screening. After confirming HIV-negative status and assessing suitability for PrEP, the clinician prescribes oral lenacapavir J0752 (300 mg) for PrEP per FDA indication. Medication dispensing is performed through the clinic pharmacy or external pharmacy; billing uses HCPCS Level II J0752. Follow-up visits occur at 1 month after initiation and then every 3 months for HIV testing, adherence counseling, STI screening, and monitoring for adverse effects. Typical site of service: outpatient clinic, community health center, or pharmacy-dispensed outpatient setting. Typical patient scenario: a 28-year-old cisgender man who has sex with men presenting after a partner disclosure of unknown HIV status; baseline labs are negative for HIV, renal function is normal, and clinician initiates oral lenacapavir J0752 for PrEP with a scheduled 1-month follow-up and quarterly monitoring.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesCommon visit code for routine PrEP follow-up visits for adherence counseling and testing
    99401Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (15 minutes)Used when dedicated, structured PrEP counseling or risk-reduction behavioral counseling is billed separately
    87802Infectious agent antigen detection by immunoassay, direct probe technique (HIV rapid test)Used for point-of-care HIV antigen/antibody testing at baseline or follow-up visits
    80053Comprehensive metabolic panelUsed for baseline and periodic renal and metabolic monitoring prior to and during lenacapavir PrEP
    87110Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolatesUsed when screening and diagnosing sexually transmitted infections from relevant specimens
    G2025Specimen collection for HIV testing (population-based) (example HCPCS/G-code use varies by payer)Used in some payer programs to capture specimen collection associated with HIV testing (payer-specific applicability)

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207Q00000X
    207L00000X
    207P00000X
    363LP0200X
    367A00000X
    3416A0800X
    207YS0123X
    207LH0002X

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    A64Unspecified sexually transmitted disease
    F10.10Alcohol abuse, uncomplicated
    F11.10Opioid abuse, uncomplicated
    F12.10Cannabis abuse, uncomplicated
    F18.10Inhalant abuse, uncomplicated
    F19.10Other psychoactive substance abuse, uncomplicated
    R10.9Unspecified abdominal pain
    R68.89Other general symptoms and signs
    Z00.00Encounter for general adult medical examination without abnormal findings
    Z00.01Encounter for general adult medical examination with abnormal findings

    Showing 1–10 of 27

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and RomidepsinMass General Brigham Health Plan2027-01-04
    Tumor Treatment Fields - Medical PolicyHealth-New-England2026-12-01
    Extracorporeal PhotopheresisCigna2026-11-15
    Electric Tumor Treatment Field Therapy (for Tennessee Only)Colorado Rocky Mountain Health Plans2026-11-01
    Tumor Treating Fields Therapypremerabluecrossofwashington2026-11-01
    Tumor Treating Fields Therapypremerabluecrossofwashington2026-11-01
    OmisirgeCigna2026-11-01
    Hematology - AdzynmaCigna2026-10-15
    Transcatheter Arterial Chemoembolization for Liver Tumorspremerabluecrossofwashington2026-10-01
    Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bonepremerabluecrossofwashington2026-10-01

    Related Codes

    HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

    HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

    HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

    HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

    HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

    HCPCS Level II J0121: Omadacycline Injection, 1 mg

    HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

    HCPCS Level II J0122: Injection, eravacycline, 1 mg

    HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

    HCPCS Level II J0129: Abatacept Injection, 10 mg

    HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

    HCPCS Level II J0130: Injection abciximab, 10 mg

    HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

    HCPCS Level II J0131: Injection, Acetaminophen 10 mg

    HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

    HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

    HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

    HCPCS Level II J0133: Injection, Acyclovir 5 mg

    HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

    HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

    Showing 1–10 of 991

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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