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 ICD-10 Codes. The Allowable PrEP-Related Medical Services list 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.
Newly Added ICD-10 Codes
The following ICD-10 codes have been added to Allowable PrEP-Related Medical Services effective May 12, 2025. These ICD-10 Codes are specific to rapid antiretroviral therapy (ART) for HIV seroconversion, hepatitis C virus (HCV) treatment, and gender affirming care.
Rapid ART- HIV seroconversion:
- B20 - Human immunodeficiency virus disease
- Z21 - Asymptomatic human immunodeficiency virus infection status
- Z79.899 - Other long term (current) drug therapy
HCV Treatment:
- B18.1 - Chronic viral Hep. C
- B18.2 - Chronic viral Hep. C with cirrhosis
- B17.1 - Acute viral Hep. C
- B19.20 - Unspecified viral hepatitis, without hepatic coma
- Z79.899 - Other long term (current) drug therapy
Gender Affirmation:
- F64.1 - Gender identity disorder of adolescence and adulthood
- F64.8 - Other gender identity disorders
- F64.9 - Gender identity disorder, unspecified
- Z79.890 - Long-term use of other hormone therapy
- Z89.890 - Personal history of sex reassignment
PrEP-AP requests that you share this information with your clinical, billing, and leadership teams.
If you have any questions regarding the information provided in this memo, please contact your OA Advisor.
Thank you,
Joseph Lagrama
ADAP Branch Chief
California Department of Public Health