Allowable PrEP Related Medical Services for PrEP-AP Temporary Coverage and Immediate Access
Updated as of July 13, 2022
The California Department of Public Health, Office of AIDS (OA), Pre-Exposure Prophylaxis (PrEP) Assistance Program (PrEP-AP) provides assistance with medical out-of-pocket costs for clients enrolled in PrEP-AP Temporary Coverage or PrEP-AP Immediate Access 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 Clinical Provider Network to provide services to uninsured clients, minors (12-17), and clients with confidentiality concerns.
Clients enrolled in PrEP-AP Temporary Coverage and clients enrolled in PrEP-AP Immediate Access who are enrolled as uninsured, minors, or clients with confidentiality concerns must receive services at approved locations within the PrEP-AP Provider Network. Clients enrolled in PrEP-AP Immediate Access as insured must recieve services through a provider in their health plan network. A Provider Referral Form for uninsured clients is not required for clients enrolled in PrEP-AP Temporary Coverage or PrEP-AP Immediate Access. Any medical service not on this list will not be reimbursable by PrEP-AP. Clients can access full PrEP-AP benefits by enrolling into PrEP-AP through a PrEP-AP Enrollment Worker at a PrEP-AP Enrollment Site.
Office Visit – Outpatient Service – Medication Administration
||New Patient Office or Other Outpatient Service (20 minutes)
||Established Patient Office or Other Outpatient Service (5 minutes)
||Established Patient Office or Other Outpatient Service (10 minutes)
||HTLV/HIV Confirmatory Test
||HIV-1/HIV-2, Type Diffrentiating Assay (Bio Rad Geenius)
||HIV-1/2 Antigen and Antibodies, Fourth Generation with Reflexes
||HIV-1 AG, EIA
||HIV-1, DNA, DIR Probe
||HIV-1, RNA, Qualititive, PCR
||HIV-1, Viral Load (RNA, Quant)
||HIV-2 DNA, DIR Probe
||HIV-2, DNA, AMP Probe
||HIV-2, DNA, Quant