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

PrEP-AP PPM 2025-04

December 30, 2025

TO:

PrEP-AP CLinical Providers

SUBJECT:

Increased Reimbursement Rates for Allowable PrEP-AP Related Laboratory Services

The purpose of this memo is to inform Pre-Exposure Prophylaxis Assistance Program (PrEP-AP) Clinical Providers (CP) about policy updates regarding PrEP-AP's allowable PrEP related laboratory reimbursement rates.

The Allowable PrEP Related Medical Services outlines the services for which patient out-of-pocket costs may be billed to PrEP-AP's medical benefits manager, Pool Administrators, Inc. (PAI). This document includes relevant Current Procedural Terminology (CPT) codes, reimbursement rates for services, and PrEP-related International Classification of Diseases, Tenth Revision (ICD-10) codes.

Effective January 29, 2026, PrEP-AP is increasing the cap reimbursement rates for laboratory reimbursement rates. This adjustment is intended to better align with current market rates and ensure continued access to essential PrEP-related laboratory services for eligible patients.

Providers are encouraged to review the updated reimbursement schedule on the Allowable PrEP Related Medical Services and ensure billing practices reflect the revised rates. For questions or additional guidance, please contact the PrEP-AP Support Team at PrEP.Support@cdph.ca.gov. The updated rates are listed below.

CPT Code	Reimbursement Rate	Description
36415	$ 13.64	Collection of venous blood by venipuncture
80053	$ 15.84	Renal Function Testing
80061	$ 20.09	Cholesterol and Triglyceride Screening
80074	$ 71.45	Hepatitis B Screening
81001	$ 4.75	Other Testing
81025	$ 12.92	Pregnancy Testing
82465	$ 6.53	Cholesterol and Triglyceride Screening
82565	$ 7.68	Renal Function Testing
82570	$ 7.77	Renal Function Testing
82575	$ 14.19	Renal Function Testing
83718	$ 12.29	Cholesterol and Triglyceride Screening
83719	$ 19.13	Cholesterol and Triglyceride Screening
83721	$ 15.75	Cholesterol and Triglyceride Screening
84460	$ 7.95	Liver Function Testing
84478	$ 8.61	Cholesterol and Triglyceride Screening
84702	$ 22.58	Pregnancy Testing
84703	$ 11.28	Pregnancy Testing
84704	$ 22.94	Pregnancy Testing
85025	$ 11.66	HIV Testing
85026	$ 11.66	HIV Testing
85027	$ 9.71	HIV Testing
86359	$ 56.60	HIV Testing
86592	$ 6.41	STI Testing
86593	$ 6.60	STI Testing
86689	$ 29.03	HIV Testing
86701	$ 13.34	HIV Testing
86702	$ 20.28	HIV Testing
86703	$ 20.57	HIV Testing
86705	$ 17.66	Hepatitis B Screening
86706	$ 16.11	Hepatitis B Screening
86708	$ 18.59	Hepatitis A Screening
86780	$ 19.86	STI Testing
86803	$ 21.41	Hepatitis C Screening
86804	$ 23.24	Hepatitis C Screening
87070	$ 12.93	STI Testing
87081	$ 9.95	STI Testing
87110	$ 29.40	STI Testing
87164	$ 16.11	STI Testing
87166	$ 16.95	STI Testing
87205	$ 6.41	STI Testing
87270	$ 17.97	STI Testing
87285	$ 18.27	STI Testing
87320	$ 22.50	STI Testing
87340	$ 15.50	Hepatitis B Screening
87341	$ 15.50	Hepatitis B Screening
87350	$ 17.30	Hepatitis B Screening
87389	$ 36.12	HIV Testing
87390	$ 36.09	HIV Testing
87391	$ 32.85	HIV Testing
87490	$ 34.13	STI Testing
87491	$ 52.64	STI Testing
87492	$ 80.21	STI Testing
87506	$ 394.49	Infectious agent detection; gastrointestinal pathogen
87522	$ 64.26	Hepatitis C Screening
87534	$ 32.88	HIV Testing
87535	$ 52.64	HIV Testing
87536	$ 127.65	HIV Testing
87537	$ 32.88	HIV Testing
87538	$ 52.64	HIV Testing
87539	$ 87.93	HIV Testing
87590	$ 40.32	STI Testing
87591	$ 52.64	STI Testing
87592	$ 64.26	STI Testing
87593	$ 52.64	MPX Testing
87800	$ 65.51	STI Testing
87801	$ 105.30	STI Testing
87806	$ 49.16	HIV Testing
87900	$ 195.53	HIV Testing
87901	$ 386.18	HIV Testing
87906	$ 193.10	HIV Testing
87505	$ 192.44	Infectious agent detection; gastrointestinal pathogen
87507	$ 625.17	Infectious agent detection; gastrointestinal pathogen
87045	$ 14.16	Infectious agent detection; gastrointestinal pathogen
G0432	$ 29.36	Infectious agent antibody detection by enzyme immunoassay (EIA) technique
G0433	$ 27.44	Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique
G0435	$ 17.97	Infectious agent antibody detection by rapid antibody test.
G0475	$ 36.12	HIV antigen/antibody, combination assay, screening
86704	$ 18.08	Hepatitis B core antibody (HBcAb); total
87467	$ 97.98	Hepatitis B surface antigen (HBsAg), quantitative
G0472	$ 69.53	Hepatitis C antibody screening, for individuals at high risk and other covered indication(s)
G0499	$ 42.41	Hepatitis B screening in non-pregnant, persons at high risk- includes hepatitis B surface antigen (HBsAg), antibodies to HBsAg (anti-HBs) and antibodies to hepatitis b core antigen (anti-HBc), and is followed by a neutralizing confirmatory test, when performed, only for an initially reactive HBsAG result
87329	$ 17.97	Giardia ag ia
87269	$ 20.42	Giardia ag if
87449	$ 17.97	Infectious Agent Antigen, EIA - can be used for Campylobacter antigen detection
87046	$ 14.16	Stool culture nos each organism ag ia
87427	$ 17.97	Stool culture culture aerobic bact
87177	$ 13.35	Stool culture for ova and parasites
87086	$ 12.11	Urine culture/colony count
87480	$ 30.08	Candida dna dir probe
87510	$ 30.08	Gardner vag dna dir probe
87660	$ 30.08	Trichomonas vagin dir probe
87902	$ 386.18	Hepatitis C Genotype
86694	$ 21.59	Herpes Simplex Virus (HSV) antibody test
86695	$ 19.79	Herpes Simplex Virus (HSV) type 1 antibody test
86696	$ 29.03	Herpes Simplex Virus (HSV) type 2 antibody test
87528	$ 30.08	Herpes Simplex Virus (HSV) type 1 and 2 DNA direct probe
87529	$ 52.64	Herpes Simplex Virus (HSV) type 1 and 2 DNA qualitative PCR
87661	$ 52.64	Trichomonas vaginalis amplif
86709	$ 16.89	Hepatitis A igm antibody
81003	$ 3.38	Urinalysis by dip stick or tablet reagent
86317	$ 15.74	Test - Hepatitis
84443	$ 25.20	Part of thyroid panel
84439	$ 13.53	Part of thyroid panel
84481	$ 25.41	Part of thyroid panel
82670	$ 41.91	Measure estradiol levels
84403	$ 38.72	Measure total testosterone levels
84402	$ 38.21	Measure free testosterone levels
84144	$ 31.29	Measure progesterone levels
84270	$ 32.60	Assess sex hormone-binding globulin
84146	$ 29.07	Monitor prolactin levels, especially for estrogen
82627	$ 33.35	Assess adrenal function
82306	$ 44.40	Evaluate bone health
84153	$ 27.59	Screen prostate health
83525	$ 17.15	Monitor metabolic changes
83036	$ 14.57	Assess blood sugar control
86141	$ 19.43	Evaluate inflammation levels
82728	$ 20.45	Assess ferritin levels
83540	$ 9.71	Assess total iron-binding capacity
82533	$ 24.45	Monitor adrenal function
77080	$ 57.26	Assess bone health
80081	$ 112.29	Blood test panel for obstetrics ( cbc, differential wbc count, hepatitis b,
80055	$ 71.72	Obstetric blood test panel
85049	$ 6.72	Platelet count, automated test
81596	$ 108.29	Biochemical assays for evaluation of chronic Hepatitis C virus infection
85610	$ 6.44	Blood test, clotting time
87563	$ 52.64	Detection of Mycoplasma genitalium by DNA or RNA probe
J0738	$ 19.68	Injection, lenacapavir, 1 mg, FDA approved prescription, only for use as HIV pre-exposure prophylaxis (not for use as treatment for HIV)
J0752	$ 587.88	Oral, lenacapavir, 300 mg, FDA approved prescription, only for use as HIV pre-exposure prophylaxis (not for use as treatment for HIV)