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    v1.0.30
    OpenPayerBilling CodesDrugs Administered Other than Oral MethodHCPCS hcpcs-j0799-hiv-pre-exposure-prophylaxis-drug
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    HCPCS Level II J0799: HIV Pre-Exposure Prophylaxis Drug

    HCPCS Level II code J0799 represents an FDA-approved prescription drug product indicated only for HIV pre-exposure prophylaxis (PrEP) and not for HIV treatment; the code is used for billing a prescription antiretroviral provided as a preventive medication, typically classified as a pharmaceutical/infusible drug service and commonly administered or dispensed in outpatient clinic pharmacies, specialty infusion centers, or retail/clinic-based dispensaries.

    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 sexually active adult patient presents to an outpatient infectious disease, sexual health, or primary care clinic requesting HIV pre-exposure prophylaxis (PrEP). The patient undergoes initial screening including HIV antigen/antibody testing, renal function assessment (serum creatinine and eGFR), hepatitis B serology, and a sexual health risk assessment. After negative HIV testing and acceptable renal function, the clinician prescribes an FDA‑approved PrEP medication billed with J0799 for administration or supply per payer policy. Typical workflow includes counseling on adherence, counseling about sexually transmitted infection prevention, ordering baseline laboratories, scheduling follow-up visits at 1 month and then quarterly, and documenting medical necessity. Typical sites of service include outpatient clinic, sexually transmitted infection clinic, community health center, or specialty infectious disease clinic. Common patient scenario: a 28‑year‑old cisgender man who has sex with men, reports recent condomless receptive anal sex with partners of unknown HIV status, has negative HIV testing today, creatinine within normal limits, and requests PrEP initiation. The medication is dispensed or administered per facility process and billed as J0799 with applicable modifiers when required.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99401Preventive medicine counseling, individual, approximately 15 minutesUsed when brief PrEP counseling or risk‑reduction counseling is provided during the visit.
    99402Preventive medicine counseling, individual, approximately 30 minutesUsed when extended counseling (for example adherence counseling and risk‑reduction education) is provided at initiation.
    87880Infectious agent detection by immunoassay with direct optical observation (e.g., rapid HIV test)Used for point‑of‑care HIV screening prior to PrEP initiation when billed separately.
    36415Collection of venous blood by venipunctureUsed for baseline and monitoring laboratory draws (HIV serology, creatinine, hepatitis B testing).
    86592Syphilis test, Qualitative non-treponemal (e.g., RPR)Common STI screening performed at baseline or follow-up visits alongside PrEP management.

    Related Modifiers

    6 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…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207Q00000X
    207RH0000X
    208D00000X
    363L00000X
    367A00000X
    111NR0400X
    163WE0003X
    207RA0002X

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    A64Unspecified sexually transmitted disease
    B20Human immunodeficiency virus [HIV] disease
    F11.10Opioid abuse, uncomplicated
    F14.10Cocaine abuse, uncomplicated
    F17.210Nicotine dependence, cigarettes, uncomplicated
    F45.41Pain disorder exclusively related to psychological factors
    R68.82Decreased libido
    R68.89Other general symptoms and signs
    Z00.00Encounter for general adult medical examination without abnormal findings
    Z11.3Encounter for screening for infections with a predominantly sexual mode of transmission

    Showing 1–10 of 24

    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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