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 insurance and medical benefits manager, Pool Administrators, Inc. (PAI). It also includes relevant Current Procedural Terminology (CPT) codes and reimbursement rates for services.
Updated Allowable PrEP Related Services
| CPT Code | Description | Reimbursement Rate |
| J0739 | Injection, cabotegravir 1 mg | $11.35 |
| 90739 | HEPB VACC 2/4 DOSE ADULT IM | $182.02 |
| 86317 | Hepatitis immunoassay infectious agent | $10.49 |
| 84443 | Assay thyroid stim hormone | $16.80 |
| 84439 | Assay of free thyroxine | $9.02 |
| 84481 | Free assay (FT-3) | $16.94 |
| 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 |
| CPT Code | Description | Reimbursement Rate |
| 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 |
| 99401 | Preventive Medicine Visits -approximately 15 minutes | $12.94 |
| 99402 | Preventive Medicine Visits approximately 30 minutes | $25.58 |
| 99403 | Preventive Medicine Visits approximately 45 minutes | $38.37 |
| 99404 | Preventive Medicine Visits approximately 60 minutes | $51.16 |
| 99411 | Preventive Medicine Visits approximately 30 minutes | $18.79 |
| 99412 | Preventive Medicine Visits approximately 60 minutes | $23.27 |
| 99384 | Preventive Medicine Visits Age 12-17 | $65.78 |
| 99385 | Preventive Medicine Visits Age 18-39 | $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 |
| 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 |
| 85049 | Platelet count, automated test | $4.48 |
| 81596 | Biochemical assays for evaluation of chronic Hepatitis C virus infection | $72.19 |
| 85610 | Blood test, clotting time | $4.29 |
| CPT Code | Description | Reimbursement Rate |
| 87563 | Detection of Mycoplasma genitalium by DNA or RNA probe | $35.09
|
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 Health