`J0799` Hiv prep, fda approved, noc

Fda approved prescription drug, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv), not otherwise classified

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medicare pricing for J0799

Physician Fee Schedule (CY 2026, RVU26D)

Status X: statutory exclusion, not paid under the PFS.

Payer policies and prior authorization for J0799

3 of 3 payer prior-auth lists that name J0799 require prior authorization or set conditions: Cigna.

Payer	Plan	State	Prior auth	Since	Source
Cigna	ACA/IFP	All	prior auth required	Jan 28, 2026	Master Precertification List (For Health Care Providers)
Cigna	Basic Standard	All	prior auth required	Jan 28, 2026	Master Precertification List (For Health Care Providers)
Cigna	Complete/PHS+/Preferred	All	prior auth required	Jan 28, 2026	Master Precertification List (For Health Care Providers)

Payer coverage policies that name J0799

J0799 appears in 1 coverage policy from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Injectable Medications (0020)	listed, no stance (range J0278-J2543)	Mar 5, 2026	payer document

Recent prior-auth changes

Nov 1, 2025: PA removed, UnitedHealthcare
Apr 1, 2025: conditions changed, UnitedHealthcare
Mar 1, 2025: conditions changed, UnitedHealthcare
Jan 1, 2025: PA added, UnitedHealthcare

Medicaid fee-for-service

Prior authorization required or conditional in IN, NE, VT.

KY: $0.00 (asc), effective Jan 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

J0799 Hiv prep, fda approved, noc