The purpose of this PrEP-AP Provider Policy Memorandum (PPM) is to notify PrEP-AP Clinical Network Providers of a required update to the Allowable PrEP Related Medical Services resulting from the American Medical Association (AMA) 2026 current procedural terminology (CPT) code revision. This PPM adds CPT codes 87494 and 90656 to the Allowable PrEP-Related Medical Services, effective January 1, 2026.
Background
Effective January 1, 2026, the AMA revised the CPT code that combined two separate Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) amplified probe codes into a single combined code:
| Status | CPT Code | Description | PrEP-AP Rate |
| ADDED | 87494 | CT / N. gonorrhoeae, DNA, Amplified Probe (combined) | $105.28 |
| ADDED | 90656 | Influenza Virus vaccine | $27.68
|
Testing at multiple anatomic sites (urogenital, rectal, pharyngeal) remains allowable under PrEP-AP. Providers must continue to append modifier 59 to claims for multi-site STI testing to prevent duplicate code edits.
Effective June 16, 2026, the following changes are made to the Allowable PrEP-Related Medical Services:
• CPT 87494 (CT/N. gonorrhoeae, DNA, Amplified Probe, combined) is ADDED to the Allowable PrEP-Related Medical Services at the CDPH reimbursement rate of $105.25,
• CPT 87491 (Chlamydia trachomatis, DNA, Amplified Probe) and CPT 87591 (N. gonorrhoeae, DNA, Amplified Probe) will continue to be on the Allowable PrEP-Related Medical Services list and be reimbursed.
• CPT 90656 (Influenza Virus vaccine) is ADDED to the Allowable PrEP-Related Medical Services at the CDPH reimbursement rate of $27.68
• All other codes on the Allowable PrEP-Related Medical Services remain in effect and are not affected by this change.
PrEP-AP's medical benefits manager, Pool Administrators, Inc. (PAI), has been notified of this policy update and will accept claims submitted with CPT 87494 and 90656 effective June 16, 2026, PAI has begun reprocessing PrEP-AP claims in which one or both of the applicable CPT codes were previously denied as a non-covered charge. Providers with claims denied between January 1, 2026, and June 15, 2026, that include CPT code 87494 or 90656 may contact PAI at (877) 495-0990 to check the status of retroactive reprocessing.
If you have any questions regarding the information provided in this memo, please contact your OA Advisor or direct questions to the PrEP-AP Support Team at PrEP.Support@cdph.ca.gov.
PrEP-AP requests that you share this memo with your clinical, billing, and leadership staff.
Thank you,
Joseph Lagrama
ADAP Branch Chief
California Department of Public Health