​Overview

The purpose of this memo is to notify AIDS Drug Assistance Program (ADAP) Enrollment Workers and PrEP-AP Clinical Providers of updates to the Allowable ADAP Related Medical Services. The Allowable ADAP Related Medical Services describes services for which patient out-of-pocket costs can be billed to ADAP's medical benefits manager, Pool Administrators, Inc. (PAI). It also includes relevant Current Procedural Terminology (CPT) codes, reimbursement rates for services, and HIV related International Classification of Diseases, Tenth Revision (ICD-10) codes.

CPT Code Updates

The following CPT codes have been added to the Allowable ADAP Related Medical Services list​ effective February 19, 2024:

• 90472 – Immunization Administration
• 90473 – Immunization Administration
• 90474 – Immunization Administration
  

Reimbursement Rate Updates

The Allowable ADAP Related Medical Services list has been updated to reflect the current Medicare reimbursement rate for all services. The updated reimbursement rates go into effect on February 19, 2024. 

ADAP requests that you share this information with your clinical and leadership teams.

If you have any questions regarding the information provided in this memo, please contact your OA Advisor.

Thank you,