Skip Navigation LinksPPM-2024-01 PPM 2024-01 Updated PrEP-AP Allowable PrEP Related Services

State of Cal Logo
EDMUND G. BROWN JR.
Governor

State of California—Health and Human Services Agency
California Department of Public Health


Provider Policy Memorandum Number: 2024-01
January 12, 2024


TO:
PrEP-AP Clinical Providers

SUBJECT:
Updated PrEP-AP Allowable PrEP Related Medical Services, ICD-10 Codes, and Reimbursement Rates

​​



​Overview

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 Relate​​d Medical Services describes 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.

Updated ICD-10 Codes

The following ICD-10 codes have been added to the Allowable PrEP Related Medical Services effective January 4, 2024. Please note the code Z29.81, which is specific to a PrEP encounter.

F11.10​​​
OPIOID ABUSE, UNCOMPLICATED
F11.20OPIOID DEPENDENCE, UNCOMPLICATED
F11.21
OPIOID DEPENDENCE IN REMISSION
F11.90OPIOID USE, UNCOMPLICATED
Z20.828CONTACT WITH AND EXPOSURE TO OTHER VIRAL COMMUNICABLE DISEASES
Z20.89CONTACT WITH AND (SUSPECTED) EXPOSURE TO OTHER VIRAL COMMUNICABLE DISEASES
Z29.81ENCOUNTER FOR HIV PRE-EXPOSURE PROPHYLAXIS
Z32.00ENCOUNTER FOR PREGNANCY TEST RESULT UNKNOWN
Z32.01ENCOUNTER FOR PREGNANCY TEST RESULT POSITIVE
Z32.02ENCOUNTER FOR PREGNANCY TEST RESULT NEGATIVE
Z86.59PERSONAL HISTORY OF OTHER MENTAL AND BEHAVIORAL DISORDERS
Z87.898PERSONAL HISTORY OF OTHER SPECIFIED CONDITIONS

Reimbursement Rate Updates

The Allowable PrEP Related Medical Services List has been updated to reflect ​​the current Medicare reimbursement rate for all services. The updated reimbursement rates go into effect on January 4, 2024. You can view the updated Allowa​​ble PrEP Related Medical Services on the California Department of Public Health (CDPH) website. ​

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 Signature

Joseph Lagrama

ADAP Branch Chief

California Department of Public Health