​Overview

The purpose of this Pre-Exposure Prophylaxis Assistance Program (PrEP-AP) Provider Policy Memorandum is to notify PrEP-AP clinical providers of the addition of gastrointestinal pathogen panels to PrEP-AP's Allowable PrEP Related Medical Services. The Allowable PrEP Related Medical Services are services for which patient out-of-pocket costs can be billed to PrEP-AP's medical benefits manager, Pool Administrators, Inc. (PAI). It also includes relevant Current Procedural Terminology (CPT) codes, reimbursement rates for services, and PrEP-related International Classification of Diseases, Tenth Revision (ICD-10) codes.

Testing for Shigella infection

Shigella is a bacterium that causes a diarrheal illness with symptoms that range from mild to severe. Shigella germs can be easily and rapidly spread during sex and gay, bisexual, and other men who have sex with men (MSM) are at higher risk for developing drug resistant Shigella infections that require laboratory testing to diagnose. For more information, please reference the Centers for Disease Control and Prevention's Shigella Infection Information for Healthcare Professionals.

Addition of Allowable PrEP Related Medical Services

The Allowable PrEP Related Medical Services list has been updated to include the following gastrointestinal pathogen panels that will be reimbursed for PrEP clients as of November 1, 2023:

• CPT Code 87505 - Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen, 3 – 5 targets
• CPT Code 87506 - Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen, 6 – 11 targets
• CPT Code 87507 - Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen, 12 – 25 targets
• CPT Code 87045 –Culture, bacterial; stool, aerobic, with isolation and preliminary examination (e.g., KIA, LIA), Salmonella, Shigella species
  

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 P​​rEP Related Medical Services, please contact PrEP-AP at PrEP.Support@cdph.ca.gov.

Thank you,

Joseph Lagrama

ADAP Branch Chief

California Department of Public Health​