Inj lenacapavir (hiv tx) 1mg
Products billed under this code include Sunlenca.
Payment limit per 1 MG, by effective quarter, 4Q23 to 4Q26. Gaps mean the code was not in that quarter’s file, or CMS gave no payment limit.Products billed under J1961
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 |
|---|---|---|---|---|
| Sunlenca | Gilead Sciences, Inc. | 61958-3002-01 | 927 | $21,262.599 |
| Sunlenca | Gilead Sciences, Inc. | 61958-3005-01 | 927 | $21,262.599 |
Every quarter
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $22.937 | +$0.001 | 1 MG | Inj lenacapavir (hiv tx) 1mg | v1, posted September 17, 2026 |
| 3Q26 | $22.936 | +$0.638 | 1 MG | Inj lenacapavir (hiv tx) 1mg | v1, posted September 15, 2026 |
| 2Q26 | $22.298 | $0.00 | 1 MG | Inj lenacapavir (hiv tx) 1mg | v1, posted September 15, 2026 |
| 1Q26 | $22.298 | +$0.145 | 1 MG | Inj lenacapavir (hiv tx) 1mg | v1, posted September 15, 2026 |
| 4Q25 | $22.153 | +$0.129 | 1 MG | Inj lenacapavir (hiv tx) 1mg | v1, posted September 8, 2026 |
| 3Q25 | $22.024 | −$0.006 | 1 MG | Inj, lenacapavir, 1 mg | v1, posted March 10, 2026 |
| 2Q25 | $22.03 | +$0.048 | 1 MG | Inj, lenacapavir, 1 mg | v1, posted March 10, 2026 |
| 1Q25 | $21.982 | −$0.011 | 1 MG | Inj, lenacapavir, 1 mg | v1, posted December 19, 2025 |
| 4Q24 | $21.993 | +$0.076 | 1 MG | Inj, lenacapavir, 1 mg | v1, posted June 11, 2025 |
| 3Q24 | $21.917 | −$0.096 | 1 MG | Inj, lenacapavir, 1 mg | v1, posted June 11, 2025 |
| 2Q24 | $22.013 | +$0.08 | 1 MG | Inj, lenacapavir, 1 mg | v1, posted March 11, 2025 |
| 1Q24 | $21.933 | +$0.14 | 1 MG | Inj, lenacapavir, 1 mg | v1, posted December 19, 2024 |
| 4Q23 | $21.793 | – | 1 MG | Inj, lenacapavir, 1 mg | v1, posted October 10, 2024 |
“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
- 3Q25: 2026-03-10_july-2025-asp-pricing-file.zipposted March 10, 2026
- 2Q25: 2026-03-10_april-2025-asp-pricing-file.zipposted March 10, 2026
- 1Q25: 2025-12-19_january-2025-asp-pricing-file-03-11-25-final-file.zipposted December 19, 2025
- 4Q24: 2025-06-11_october-2024-asp-pricing-file.zipposted June 11, 2025
- 3Q24: 2025-06-11_july-2024-asp-pricing-file.zipposted June 11, 2025
- 2Q24: 2025-03-11_april-2024-asp-pricing-file.zipposted March 11, 2025
- 1Q24: 2024-12-19_january-2024-asp-pricing-file.zipposted December 19, 2024
- 4Q23: 2024-10-10_october-2023-asp-pricing-file.zipposted October 10, 2024