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OA ADAP Allowable PrEP Related Medical Services List

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Allowable Pre-Exposure Prophylaxis (PrEP) Related Medical Services

Effective March 11, 2025

The California Department of Public Health, Office of AIDS (OA), PrEP Assistance Program (PrEP-AP) provides assistance with medical out-of-pocket costs for clients for the PrEP-related services identified below. For reimbursement, all claims must include: 1) a CPT code indicating the procedure or counseling session received, and 2) the ICD-10 code(s) substantiating the reason for the provider visit as being PrEP-related.

Please Note: Reimbursement rates identified in the right column apply to rates paid to contracted providers in the PrEP-AP Provider Network to provide services to uninsured clients. Uninsured clients must receive services at approved locations within the PrEP-AP Provider Network. Clients with insurance will have the actual portion of their co-payment obligation charged by the insurance plan paid for by the PrEP-AP.

Office Visit – Outpatient Service – Medication Administration

CPT Codes	Description	CDPH Reimbursement Rate
99202	New Patient Office or Other Outpatient Service (20 minutes)	$72.86
99203	New Patient Office or Other Outpatient Service (30 minutes)	$112.84
99204	New Patient Office or Other Outpatient Service (45 minutes)	$167.40
99205	New Patient Office or Other Outpatient Service (60 minutes)	$220.95
99211	Established Patient Office or Other Outpatient Service (5 minutes)	$23.38
99212	Established Patient Office or Other Outpatient Service (10 minutes)	$56.93
99213	Established Patient Office or Other Outpatient Service (15 minutes)	$90.82
99214	Established Patient Office or Other Outpatient Service (25 minutes)	$128.43
99215	Established Patient Office or Other Outpatient Service (40 minutes)	$179.94
90471	Immunization Administration	$22.21
90472	Immunization Administration, Each Additional	$15.92
90473	Immunization Administration, Intranasal or Oral	$18.14
90474	Immunization Administration, Each Additional Intranasal or Oral	$12.96
90739	HEPB Vacc 2/4 DOSE Adult IM	$182.02
J0739	Injection, cabotegravir 1 mg	$11.35
96372	Therapeutic, Prophylactic, & Diagnostic Injections and Infusions	$14.23
96373	Therapeutic, Prophylactic, & Diagnostic Injections and Infusions	$18.30
99384	Preventive Medicine Visits Age 12-17	$65.78
99385	Preventive Medicine Visits Age 19-39	$114.10
99386	Preventive Medicine Visits Age 40-64	$132.20
99387	Preventive Medicine Visits Age 65 and older	$143.00
99394	Preventive Medicine Visits Age 12-17	$126.83
99395	Preventive Medicine Visits Age 18-39	$54.83
99396	Preventive Medicine Visits Age 40-64	$109.90
99397	Preventive Medicine Visits Age 65 and older	$118.40
99401	Preventive Medicine Visits - approximately 15 minutes	$12.94
99402	Preventive Medicine Visits approximately 30 minutes	$25.58
99403	Preventive Medicine Visitis approximately 45 minutes	$38.37
99404	Preventive Medicine Visitis approximately 60 minutes	$51.16
99411	Preventive Medicine Visits approximately 30 minutes	$18.79
99412	Preventive Medicine Visits approximately 60 minutes	$23.27
99421	Online Digital Evaluation and Management Service (5-10 minutes)	$14.91
99422	Online Digital Evaluation and Management Service (11-20 minutes)	$29.48
99423	Online Digital Evaluation and Management Service (21 or more minutes)	$47.10
99441	Audio-only (Telephone) Evaluation and Management Service (5-10 minutes)	$56.25
99442	Audio-only (Telephone) Evaluation and Management Service (11-20 minutes)	$90.82
99443	Audio-only (Telephone) Evaluation and Management Service (21-30 minutes)	$127.76
98970	Qualified Nonphysician Health Care Professional Online Digital Evaluation and Management Service (5-10 minutes)	$11.52
98971	Qualified Nonphysician Health Care Professional Online Digital Evaluation and Management Service (11-20 minutes)	$20.33
98972	Qualified Nonphysician Health Care Professional Online Digital Evaluation and Management Service (21-30 minutes)	$31.18
G2010	Remote Evaluation of Recorded Video and/or Images Submitted by an Established Patient	$12.20
G2012	Brief Communication Technology-based Service (5-10 minutes)	$14.23
G2250	Remote Evaluation of Recorded Video and/or Images Submitted by an Established Patient	$12.20
G2251	Brief Communication Technology-based Service (5-10 minutes)	$14.23
G2252	Brief Communication Technology-based Service (11-20 minutes)	$26.77

HIV Testing

CPT Codes	Description	CDPH Reimbursement Rate
85025	Complete Blood Cell Count (red cells, white blood cells, platelets), Automated	$7.77
85026	Complete Blood Cell Count (red cells, white blood cells, platelets), Automated	$7.77
85027	Complete Blood Cell Count (red cells, white blood cells, platelets), Automated	$6.47
86359	CD4 Cell Count	$37.73
86689	HTLV/HIV Confirmatory Test	$19.35
86701	HIV-1	$8.89
86702	HIV-2	$13.52
86703	HIV-1/HIV-2, Type Differentiating Assay (Bio Rad Geenius)	$13.71
87389	HIV-1/2 Antigen and Antibodies, Fourth Generation with Reflexes	$24.08
87390	HIV-1 AG, EIA	$24.06
87391	HIV-2 AG, EIA	$21.90
87534	HIV-1, DNA, DIR Probe	$21.92
87535	HIV-1, RNA, Qualitative, PCR	$35.09
87536	HIV-1, Viral Load (RNA, Quant)	$85.10
87537	HIV-2, DNA, DIR Probe	$21.92
87538	HIV-2, DNA, AMP Probe	$35.09
87539	HIV-2, DNA, Quant	$58.62
87806	HIV-1 Antigen and Antibodies, with HIV 1/2 Antibodies	$32.77
87900	HIV-1 Drug Resistance Assay - Phenotype Prediction Using Genotype Bioinformatics	$130.35
87901	HIV-1 Drug Resistance Assay - Protease and Reverse Transcriptase Genotype	$257.45
87906	HIV-1 Drug Resistance Assay - Integrase Genotype	$128.73
G0432	HIV-1/2 Antigen/Antibody, EIA	$19.57
G0433	HIV-1/2 Antigen/Antibody, ELISA	$18.29
G0435	HIV-1/2 Antigen/Antibody, Rapid Oral Fluid Test	$11.98
G0475	HIV Antigen/Antibody, Combination Assay, Screening	$24.08

STI Testing

CPT Code	Description	CDPH Reimbursement Rate
86592	Blood Serology, Qualitative (Including Non-Treponemal Syphilis Tests (RPR, VRDL)	$4.27
86593	Blood Serology, Quantitative (Including RPR and VRDL Titers)	$4.40
86780	Syphilis Immunoassays (Including T. Pallidum Antibody and the TPPA Assay)	$13.24
87070	Culture, Bacteria, Other	$8.62
87081	Culture	$6.63
87110	Chlamydia, Culture	$19.60
87164	Dark Field without Specimen Collection	$10.74
87166	Dark Field with Specimen Collection	$11.30
87205	Smear Gram Stain	$4.27
87270	Chlamydia Trachomatis AG, IF	$11.98
87285	Treponema Pallidum AG, IF	$12.18
87320	Chlamydia Trachomatis AG, EIA	$15.00
87490	Chlamydia Trach, DNA DIR Probe	$22.75
87491	Chlamydia Trach, DNA AMP Probe	$35.09
87492	Chlamydia DNA or RNA, Quant	$53.47
87563	Detection of Mycoplasma genitalium by DNA or RNA probe	$35.09
87590	N. Gonorrhoeae, DNA, DIR Probe	$26.88
87591	N. Gonorrhoeae, DNA, AMP Probe	$35.09
87592	N. Gonorrhoeae, DNA, Quant	$42.84
87593	Mpox (Orthopoxvirus), DNA, PCR	$35.09
87800	Smear Gram Stain	$43.67
87801	Multiple Organism NAAT	$70.20

Pregnancy Testing

CPT Code	Description	CDPH Reimbursement Rate
81025	hCG, Qualitative, Urine	$8.61
84702	hCG Beta Subunit, Total, Quantitative, Serum	$15.05
84703	hCG Beta Subunit, Qualitative	$7.52
84704	hCG Free Beta Chain Test	$15.29
80081	Blood test panel for obstetrics (cbc, differential wbc count, hepatitis b, and HIV-1/2 Antigen and Antibodies)	$74.86
80055	Obstetric Blood test panel	$47.81

Renal Function Testing

CPT Code	Description	CDPH Reimbursement Rate
80053	Comprehensive Metabolic Panel	$10.56
82565	Creatinine, Blood	$5.12
82570	Creatinine, Blood	$5.18
82575	Creatinine, Blood	$9.46

Hepatitis A Screening

CPT Code	Description	CDPH Reimbursement Rate
86708	HAV AB	$12.39

Hepatitis B Screening

CPT Code	Description	CDPH Reimbursement Rate
80074	Acute Hepatitis Panel	$47.63
86317	Hepatitis immunoassay infectious agent	$10.49
86705	Hepatitis B Core Antibody (IGM) Measurement	$11.77
86706	HBV Surface AB	$10.74
87340	Hepatitis B Surface AG, EIA	$10.33
87341	Hepatitis B Surface AG, Immunoassay	$10.33
87350	Detection Test by Immunoassay	$11.53
86704	Hepatitis B Core Antibody (HBcAb), Total	$12.05
87467	Hepatitis B Surface Antigen (HBcAb), Quantitative	$15.05
G0499	Hepatitis B Screening	$28.27

Hepatitis C Screening

CPT Code	Description	CDPH Reimbursement Rate
81596	Biochemical assays for evaluation of chronic Hepatitis C virus infection	$72.19
85049	Platelet count, automated test	$4.48
85610	Blood test, clotting time	$4.29
86803	Hepatitis C AB Test	$14.27
86804	Hepatitis C AB Test, Confirm	$15.49
87522	Hepatitis C Viral RNA, Quantitative, Real-Time PCR	$42.84
87902	Hepatitis C Genotype	$257.45
G0472	Hepatitis C Screening	$46.35

Liver Function Test

CPT Code	Description		CDPH Reimbursement Rate

84460

Transferase Alanine Amino ALT SGPT

$5.30

Cholesterol and Triglyceride Screening

CPT Code	Description	CDPH Reimbursement Rate
80061	Lipid Panel	$13.39
82465	Cholesterol, Total	$4.35
83718	Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)	$8.19
83719	Lipoprotein, direct measurement; very low density cholesterol (VLDL cholesterol)	$12.75
83721	Lipoprotein, direct measurement; low density cholesterol (LDL cholesterol)	$10.50
84478	Triglycerides	$5.74

Other

CPT Code	Description	CDPH Reimbursement Rate
36415	Collection Venous Blood Venipuncture	$9.09
81001	Urinalysis; automated, with microscopy	$3.17
81003	Urinalysis by dip stick or tablet reagent	$2.25
87045	Infectious agent detection; gastrointestinal pathogen	$9.44
87046	Stool Culture; additional pathogens	$9.44
87086	Urine Culture; bacterial colony count	$8.07
87177	Stool for ova and parasite smear	$8.90
87269	Giardia; immunofluorescent	$13.61
87329	Giardia; immunoassay	$11.98
87427	Shiga-like toxin antigen; immunoassay	$11.98
87449	Infectious Agent Antigen; immunoassay (can be used for Campylobacter antigen detection)	$11.98
87480	Candida; direct probe	$20.05
87505	Infectious agent detection; gastrointestinal pathogen	$128.29
87506	Infectious agent detection; gastrointestinal pathogen	$262.99
87507	Infectious agent detection; gastrointestinal pathogen	$416.78
87510	Gardnerella Vaginalis; direct probe	$20.05
87660	Trichomonas Vaginalis; direct probe	$20.05

Thyroid Panel

CPT Code	Description	CDPH Reimbursement Rate
84443	Assay thyroid stim hormone	$16.80
84439	Assay of free thyroxine	$9.02
84481	Free assay (FT -3)	$16.94

Gender Affirming Care

CPT Code	Description	CDPH Reimbursement Rate
82670	Assay of total estradiol	$27.94
84403	Assay of total testosterone	$25.81
84402	Assay of free testosterone	$25.47
84144	Assay of progesterone	$20.86
84270	Assay of sex hormone globulin	$21.73
84146	Assay of prolactin	$19.38
82627	Analysis of dehydroepiandrosterone sulfate (DHEA-S)	$22.23
82306	Vitamin D 25 hydroxy	$29.60
84153	Assay of PSA Total	$18.39
83525	Assay Of Insulin	$11.43
83036	Hemoglobin glycosylated A1C	$9.71
86141	C-Reactive protein HS	$12.95
82728	Assay of ferritin	$13.63
83540	Assay of iron	$6.47
82533	Total cortisol	$16.30
77080	DXA Bone density axial	$38.17

PrEP Related ICD-10 Codes

ICD-10 Code	Description
Z29.81	Encounter for HIV Pre-Exposure Prophylaxis
Z71.7	Encounter for HIV Counseling
Z72.5	High-Risk Sexual Behavior
Z72.51	High-Risk Heterosexual Behavior
Z72.52	High-Risk Homosexual Behavior
Z72.53	High-Risk Bisexual Behavior
Z20	Contact with and (Suspected) Exposure to Communicable Disease
Z20.2	Contact with and (Suspected) Exposure to Infections with a Predominantly Sexual Mode of Transmission
Z20.5	Contact with and (Suspected) Exposure to Viral Hepatitis
Z20.6	Contact with and (Suspected) Exposure to Human Immunodeficiency Virus (HIV)
Z20.8	Contact with and (Suspected) Exposure to Other Communicable Diseases
Z20.82	Contact with and (Suspected) Exposure to Other Viral Communicable Diseases
Z20.81	Contact with and (Suspected) Exposure to Other Bacterial Communicable Diseases
Z20.9	Contact with and (Suspected) Exposure to Unspecified Communicable Diseases
Z29.8	Other Specified Prophylactic Measures
Z771.21	Contact with and (Suspected) Exposure to Potentially Hazardous Body Fluids
W46.0XXA	Contact with Hypodermic Needle (Initial Encounter)
W46.0XXD	Contact with Hypodermic Needle (Subsequent Encounter)
W46.1XXA	Contact with Contaminated Hypodermic Needle (Initial Encounter)
W46.1XXD	Contact with Contaminated Hypodermic Needle (Subsequent Encounter)
Z11.59	Encounter for Other Viral Diseases
Z70.0	Counseling Related to Sexual Attitude
Z70.1	Counseling Related to Patients Sexual Behavior and Orientation
Z11.4	Encounter for Screening for Human Immunodeficiency Virus (HIV)
Z11.3	Encounter for Screening for Infections with a Predominantly Sexual Mode of Transmission
Z01.812	Encounter for Preprocedural Laboratory Examination
Z51.81	Encounter for Therapeutic Drug Level Monitoring
Z79.899	Other Long Term (Current) Drug Therapy
F11.10	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
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

Clinically Administered Medications
PrEP-AP Allowable Clinically Administered Medications

Page Last Updated : August 28, 2025

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