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Allowable Pre-Exposure Prophylaxis (PrEP) Related Medical Services

Effective October 18, 2022

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 CodesDescriptionCDPH Reimbursement Rate
99202
New Patient Office or Other Outpatient Service (20 minutes)
$74.06
99203New Patient Office or Other Outpatient Service (30 minutes)$113.85
99204New Patient Office or Other Outpatient Service (45 minutes)$169.57
99205New Patient Office or Other Outpatient Service (60 minutes)$224.25
99211Established Patient Office or Other Outpatient Service (5 minutes)$23.53
99212Established Patient Office or Other Outpatient Service (10 minutes)$57.45
99213Established Patient Office or Other Outpatient Service (15 minutes)$92.05
99214Established Patient Office or Other Outpatient Service (25 minutes)$129.77
99215Established Patient Office or Other Outpatient Service (40 minutes)$183.07
90471Immunization Administration $16.96
96372
Therapeutic, Prophylactic, & Diagnostic Injections and Infusions$14.54
​96373
​Therapeutic, Prophylactic, & Diagnostic Injections and Infusions
​$18.34
​99421
​Online Digital Evaluation and Management Service (5-10 minutes)
​$15.23
​99422
​Online Digital Evaluation and Management Service (11-20 minutes)
​$29.76
​99423
​Online Digital Evaluation and Management Service (21 or more minutes)
​$48.45
​99441
​Audio-only (Telephone) Evaluation and Management Service (5-10 minutes)
​$56.75
​99442
​Audio-only (Telephone) Evaluation and Management Service (11-20 minutes)
​$91.71
​99443
​Audio-only (Telephone) Evaluation and Management Service (21-30 minutes)
​$129.77
​98970
​Qualified Nonphysician Health Care Professional Online Digital Evaluation and Management Service (5-10 minutes)
​$11.77
​98971
​​Qualified Nonphysician Health Care Professional Online Digital Evaluation and Management Service (11-20 minutes)
$20.79
​98972
​Qualified Nonphysician Health Care Professional Online Digital Evaluation and Management Service (21-30 minutes)
​​$32.18
​G2012
​Brief Communication Technology-based Service (5-10 minutes)
​$14.54
​G2010
​Remote Evaluation of Recorded Video and/or Images Submitted by an Established Patient
​$12.11
​G2250
​Remote Evaluation of Recorded Video and/or Images Submitted by an Established Patient
​$12.11
​G2251
​Brief Communication Technology-based Service (5-10 minutes)
​$14.54
G2252
Brief Communication Technology-based Service (11-20 minutes)
$28.03

HIV Testing

CPT CodesDescriptionCDPH 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
86359CD4 Cell Count$37.73
86689HTLV/HIV Confirmatory Test$19.35
86701HIV-1$8.89
86702HIV-2$13.52
86703HIV-1/HIV-2, Type Diffrentiating  Assay (Bio Rad Geenius)$13.71
87389HIV-1/2 Antigen and Antibodies, Fourth Generation with Reflexes$24.08
87390HIV-1 AG, EIA$24.06
87391HIV-2 AG, EIA$21.90
87534HIV-1, DNA, DIR Probe$21.92
87535HIV-1, RNA, Qualitative, PCR$35.09
87536HIV-1, Viral Load (RNA, Quant)$85.10
87537HIV-2, DNA, DIR Probe$21.92
87538HIV-2, DNA, AMP Probe$35.09
87539HIV-2, DNA, Quant
$58.62
​87806
​HIV-1 Antigen and Antibodies, with HIV 1/2 Atibodies
​$32.77
87900HIV-1 Drug Resistance Assay - Phenotype Prediction Using Genotype Bioinformatics
$130.35
87901HIV-1 Drug Resistance Assay - Protease and Reverse Trascriptase Genotype $257.45
87906HIV-1 Drug Resistance Assay - Integrase Genotype 
$128.73

STI Testing

CPT Code
DescriptionCDPH 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
Treponem 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
​87590
​N. Gonorrhoeae, DNA, DIR Probe
$26.88​
​87591
​N. Gonorrhoeae, DNA, AMP Probe
$35.09​
​87592
​N. Gonorrhoeae, DNA, Quant
​$42.84
​87593
Orthopoxvirus (e.g., MPX virus, cowpox virus, vaccinia virus), DNA or RNA AMP Probe
​$35.09
​87800
​Smear Gram Stain
$43.67​
​87801
​Multiple Organism NAAT
$70.20​

Pregnancy Testing

CPT Code
DescriptionCDPH 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

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​
​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
​HBV Core AB
$12.05​

Hepatitis C Screening

CPT Code
​Description
​CDPH Reimbursement Rate
​86803
​Hepatitis C AB Test
​$14.27
​86804
​Hepatitis C AB Test,  Confirm
​$15.49
​87522
​Hepatitis C Viral RNA, Quantitive, Real-Time PCR
​$42.84

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
​$14.27

Other

​CPT Code
Description
CDPH Reimbursement Rate
​36415
​Collection Venous Blood Venipuncture
​​$3.00
​81001
​​Urinalysis; automated, with microscopy
$3.17

PrEP Related ICD-10 Codes

ICD-10 CODE
​DESCRIPTION
​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 Realted 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 Mose 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

​Clinically Administered Medications 
​Reach out to PrEP.Support@cdph.ca.gov to request the PrEP-AP Allowable Clinically Administered Medications list.

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