āOverviewā
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 Related 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 Allowable PrEP Related Services
The following services have been added to the Allowable PrEP Related Medical Services effective March 18, 2024. Please note the code Z29.81, which is specific to a PrEP encounter.
| 87329 | Giardia, immunoassay
| $11.98 |
87269ā
| Giardia, immunofluorescent
| $13.61 |
87449
| Infectious Agent Antigen, immunoassay (can be used for Campylobacter antigen detection) | $11.98 |
| 87046 | Stool Culture, additional pathogens | $9.44 |
| 87427 | Shiga-like toxin antigen, immunoassay | $11.98 |
| 87177 | Stool for ova and parasite smear | $8.90 |
| 87086 | Urine Culture, bacterial colony count | $8.07 |
| 87480 | Candida, direct probe | $20.05 |
| 87510 | Gardnerella Vaginalis, direct probe | $20.05 |
| 87660 | Trichomonas Vaginalis, direct probe | $20.05 |
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,
Joseph Lagrama
ADAP Branch Chief
California Department of Public Healthā