āOverview
The purpose of this PrEP-AP Provider Policy Memo is to notify PrEP-AP Clinical providers of updates to PrEP-AP's Allowable PrEP Related Medical Services. The Allowable PrEP Relateāād Medical Services describes services for which patient out-of-pocket costs can be billed to PrEP-AP's medical benefits manager, Pool Administrators, Inc. (PAI). It also includes relevant Current Procedural Terminology (CPT) codes, reimbursement rates for services, and PrEP related International Classification of Diseases, Tenth Revision (ICD-10) codes.
Updated ICD-10 Codes
The following ICD-10 codes have been added to the Allowable PrEP Related Medical Services effective January 4, 2024. Please note the code Z29.81, which is specific to a PrEP encounter.
F11.10āāā
| OPIOID ABUSE, UNCOMPLICATED |
| F11.20 | OPIOID DEPENDENCE, UNCOMPLICATED |
F11.21
| OPIOID DEPENDENCE IN REMISSION |
| F11.90 | OPIOID USE, UNCOMPLICATED |
| Z20.828 | CONTACT WITH AND EXPOSURE TO OTHER VIRAL COMMUNICABLE DISEASES |
| Z20.89 | CONTACT WITH AND (SUSPECTED) EXPOSURE TO OTHER VIRAL COMMUNICABLE DISEASES |
| Z29.81 | ENCOUNTER FOR HIV PRE-EXPOSURE PROPHYLAXIS |
| Z32.00 | ENCOUNTER FOR PREGNANCY TEST RESULT UNKNOWN |
| Z32.01 | ENCOUNTER FOR PREGNANCY TEST RESULT POSITIVE |
| Z32.02 | ENCOUNTER FOR PREGNANCY TEST RESULT NEGATIVE |
| Z86.59 | PERSONAL HISTORY OF OTHER MENTAL AND BEHAVIORAL DISORDERS |
| Z87.898 | PERSONAL HISTORY OF OTHER SPECIFIED CONDITIONS
|
Reimbursement Rate Updates
The Allowable PrEP Related Medical Services List has been updated to reflect āāthe current Medicare reimbursement rate for all services. The updated reimbursement rates go into effect on January 4, 2024. You can view the updated Allowaāāble PrEP Related Medical Services on the California Department of Public Health (CDPH) website. ā
PrEP-AP requests that you share this information with your clinical and leadership teams.
If you have any questions regarding the changes to the Allowable PrEP Related Medical Services List, please contact PrEP-AP at PrEP.Support@cdph.ca.gov.
Thank you, ā
Joseph Lagrama
ADAP Branch Chief
California Department of Public Health
ā