Hiv prep, inj, lenacapavir
Products billed under this code include Yeztugo.
Payment limit per 1 MG, by effective quarter, 4Q25 to 4Q26. Gaps mean the code was not in that quarter’s file, or CMS gave no payment limit.Products billed under J0738
From the 4Q26 NDC–HCPCS crosswalk. “Limit / pkg” is the 4Q26 payment limit times the billing units in one package.
| Product | Labeler | NDC | Units / pkg | Limit / pkg |
|---|---|---|---|---|
| Yeztugo | Gilead Sciences INC. | 61958-3402-01 | 927 | $14,846.832 |
Every quarter
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $16.016 | −$0.065 | 1 MG | Hiv prep, inj, lenacapavir | v1, posted September 17, 2026 |
| 3Q26 | $16.081 | −$0.022 | 1 MG | Hiv prep, inj, lenacapavir | v1, posted September 15, 2026 |
| 2Q26 | $16.103 | −$0.03 | 1 MG | Hiv prep, inj, lenacapavir | v1, posted September 15, 2026 |
| 1Q26 | $16.133 | $0.00 | 1 MG | Hiv prep, inj, lenacapavir | v1, posted September 15, 2026 |
| 4Q25 | $16.133 | – | 1 MG | Hiv prep, inj, lenacapavir | v1, posted September 8, 2026 |
“Change” is the difference from the previous quarter, shown only when both quarters have a payment limit and the billing unit is the same. “vs. last quarter” and “vs. a year ago” follow the same rule.
CMS source files
- 4Q26: 2026-09-17_october-2026-medicare-part-b-payment-limit-files-final.zipposted September 17, 2026
- 4Q26: 2026-09-17_october-2026-ndc-hcpcs-crosswalk-final.zipposted September 17, 2026
- 3Q26: 2026-09-15_july-2026-medicare-part-b-payment-limit-files.zipposted September 15, 2026
- 2Q26: 2026-09-15_april-2026-medicare-part-b-payment-limit-files-final-file.zipposted September 15, 2026
- 1Q26: 2026-09-15_january-2026-medicare-part-b-payment-limit-files.zipposted September 15, 2026
- 4Q25: 2026-09-08_october-2025-asp-pricing-final-file.zipposted September 8, 2026