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 Related 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 Rates for Allowable PrEP Related Services
The following rates have been updated for the Allowable PrEP Related Medical Services, effective March 10, 2025.
| CPT Code | Service Description | Reimbursement Rate |
| 36415 | Collection of venous blood by venipuncture | $ 9.09 |
| 90471 | Office Visit - Outpatient | $ 20.05 |
| 90472 | IMMUNIZATION ADMIN EACH ADD | $ 14.23 |
| 90473 | Immunization admin, intranasal or oral | $ 16.17 |
90474
| Immunization admin each add'l intranasal/oral vaccine, same day | $ 11.64 |
| 96372 | Office Visit - Outpatient | $ 13.91 |
| 96373 | Office Visit - Outpatient | $ 18.44 |
| 98016 | Brief communication technology-based service | $ 15.58 |
| 98970 | Qualified nonphysician health care professional online digital evaluation and management service | $ 11.32 |
| 98971 | Qualified nonphysician health care professional online digital evaluation and management service | $ 21.35 |
| 98972 | Qualified nonphysician health care professional online digital evaluation and management service | $ 32.35 |
| 99202 | Office Visit - Outpatient | $ 69.87 |
| 99203 | Office Visit - Outpatient | $ 109.01 |
| 99204 | Office Visit - Outpatient | $ 163.35 |
| 99205 | Office Visit - Outpatient | $ 215.75 |
| 99211 | Office Visit - Outpatient | $ 22.64 |
| 99212 | Office Visit - Outpatient | $ 54.99 |
| 99213 | Office Visit - Outpatient | $ 88.95 |
| 99214 | Office Visit - Outpatient | $ 125.18 |
| 99215 | Office Visit - Outpatient | $ 175.64 |
| 99421 | Online digital evaluation and management service | $ 14.56 |
| 99422 | Online digital evaluation and management service | $ 28.46 |
| 99423 | Online digital evaluation and management service | $ 44.96 |
| G2010 | Remote evaluation of recorded video and/or images submitted by an established patient | $ 11.97 |
| G2250 | Remote evaluation of recorded video and/or images submitted by an established patient | $ 11.97 |
| G2251 | Brief communication technology-based service | $ 13.91 |
| G2252 | Brief communication technology-based service | $ 25.55 |
| 87467 | Hepatitis B surface antigen (HBsAg), quantitative | $ 25.32 |
PrEP-AP requests that you share this information with your clinical and leadership teams.
If you have any questions regarding the information provided in this memo, please contact PrEP-AP at PrEP.Support@cdph.ca.gov
Thank you,
Joseph Lagrama
ADAP Branch Chief
California Department of Public Health