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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

​CPT Codes
​Description
​CDPH Reimbursement Rate
99202
​New Patient Office or Other Outpatient Service (20 minutes)
​$73.97
​99211
​Established Patient Office or Other Outpatient Service (5 minutes)
​$23.03
​99212
​Established Patient Office or Other Outpatient Service (10 minutes)
​$56.88

HIV Testing

​CPT Codes
​Description
​CDPH Reimbursement Rates
​86689
​HTLV/HIV Confirmatory Test
​$19.35
​86701
​HIV-1
​$8.89
​86702
​HIV-2
​$13.52
​86703
​HIV-1/HIV-2, Type Diffrentiating 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, EIA
​$21.90
​87534
​HIV-1, DNA, DIR Probe
​$21.92
​87535
​HIV-1, RNA, Qualititive, 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

​STI Testing

CPT Code
DescriptionCDPH Reimbursement Rate
​86593
​Blood Serology, Quantitative (Including RPR and VRDL Titers)
​$4.40
​86780
​Syphilis Immunoassays (Including T. Pallidum Antibody and the TPPA Assay)
​$13.24
​87491
​Chlamydia Trach, DNA AMP Probe
​$35.09
​87591
​N. Gonorrhoeae, DNA, AMP Probe
$35.09​

Pregnancy Testing

CPT Code
DescriptionCDPH Reimbursement Rate
​81025
HCG, Qualitative, Urine​
$8.61​

Renal Function Testing

CPT Code
Description
CDPH Reimbursement Rate
​80053
​Comprehensive Metabolic Panel
​$10.56

Hepatitis B Screening

​CPT Code
​Description
CDPH Reimbursement Rate
​87340
Hepatitis B Surface AG, Immunoassay​
$10.33​

Hepatitis C Screening

CPT Code
​Description
​CDPH Reimbursement Rate
​86803
​Hepatitis C AB Test
​$14.27

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