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See a sample rate comparisonHCPCS J1961 (Sunlenca) Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Injection, lenacapavir (only for use as hiv treatment), 1 mg
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Common Place of Service | 11 - Office None 22 - On Campus Outpatient Hospital 50 - Federally Qualified Health Center 17 - Walk-in Retail Health Clinic |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J1961 |
| Medicare Payment Limit | $22.153  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 61958-3002-01 - SUNLENCA (PF,LATEX-FREE) 309 MG/1 ML • 61958-3005-01 - SUNLENCA 309 MG/1 ML |
National average reimbursement for HCPCS J1961 by major payers:
$32.83
$22.44
$24.33
$23.78
Compare published rates across providers.
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HCPCS J1961
5 of 25 sample ratesHigher to lower in this preview
Takoma Regional Hospital Inc, Ballad Health Medical Associates
Takoma Regional Hospital Inc
$137.39Published rateCabell Huntington Hospital Inc
$24.95Published rateDavis Memorial Hospital, Davis Medical Center
Davis Memorial Hospital
$21.98Published rateCommunity Memorial Hospital Of Menomonee Falls Inc, Froedtert Menomonee Falls Hospital
Froedtert Memorial Lutheran Hospital Inc
$21.97Published rateSt. Agnes Healthcare, Inc., St.Agnes Hospital
St Agnes Healthcare Inc
$20.00Published rate
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See a sample payer proposalHCPCS J1961 vs. Other Drugs, Administered by Injection Codes
The HCPCS J1961 code is part of the Drugs Administered Other than Oral Method services used for Drugs, Administered by Injection. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS J1961 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 61958-3002-01-NDC | Moderate | SUNLENCA (PF,LATEX-FREE) 309 MG/1 ML |
| 61958-3005-01-NDC | Moderate | SUNLENCA 309 MG/1 ML |
| J1960-HCPCS | Low | Injection, levorphanol tartrate, up to 2 mg |
| J1961-HCPCS | Low | Injection, lenacapavir (only for use as hiv treatment), 1 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J1961. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J1961 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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