J1961 — Injection, lenacapavir (only for use as hiv treatment), 1 mg
J1961 is a HCPCS Level II code for injection, lenacapavir (only for use as hiv treatment), 1 mg. It belongs to the Drugs Administered Other Than Oral Method section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusE
Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).
Global period: XXX
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The CMS record for J1961
- Long descriptor
- Injection, lenacapavir (only for use as hiv treatment), 1 mg
- Short descriptor
- Inj lenacapavir (hiv tx) 1mg
- Added
- July 1, 2023
- BETOS
- O1E
- Pricing indicator
- 51 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Drugs.
Codes adjacent to J1961
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J1961 is not quite right, the correct code is very often within a few positions of it.
- J1950Injection, leuprolide acetate (for depot suspension), per 3.75 mg
- J1951Injection, leuprolide acetate for depot suspension (fensolvi), 0.25 mg
- J1952Leuprolide injectable, camcevi, 1 mg
- J1953Injection, levetiracetam, 10 mg
- J1954Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mg
- J1955Injection, levocarnitine, per 1 gm
- J1956Injection, levofloxacin, 250 mg
- J1960Injection, levorphanol tartrate, up to 2 mg
- J1980Injection, hyoscyamine sulfate, up to 0.25 mg
- J1990Injection, chlordiazepoxide hcl, up to 100 mg
- J2001Injection, lidocaine hcl for intravenous infusion, 10 mgterminated
- J2002Injection, lidocaine hcl in 5% dextrose, 1 mg
- J2003Injection, lidocaine hydrochloride, 1 mg
- J2004Injection, lidocaine hcl with epinephrine, 1 mg
- J2010Injection, lincomycin hcl, up to 300 mg
- J2020Injection, linezolid, 200 mg
Questions about J1961
What is HCPCS code J1961?
J1961 is a HCPCS Level II code for injection, lenacapavir (only for use as hiv treatment), 1 mg. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J1961?
The CMS HCPCS file marks J1961 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is J1961 paid under the physician fee schedule?
J1961 carries PFS status code E. Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).