Allowable PrEP Related Medical Services for PrEP-AP Temporary Coverage and Immediate Access

Updated as of July 13, 2022

The California Department of Public Health, Office of AIDS (OA), Pre-Exposure Prophylaxis (PrEP) Assistance Program (PrEP-AP) provides assistance with medical out-of-pocket costs for clients enrolled in PrEP-AP Temporary Coverage or PrEP-AP Immediate Access for the PrEP-related services identified below. For reimbursement, all claims must include: 1) a CPT code indicating the procedure or counseling session received, and 2) the ICD-10 code(s) substantiating the reason for the provider visit as being PrEP-related.

Please Note: Reimbursement rates identified in the right column apply to rates paid to contracted providers in the PrEP-AP Clinical Provider Network to provide services to uninsured clients, minors (12-17), and clients with confidentiality concerns. Clients enrolled in PrEP-AP Temporary Coverage and clients enrolled in PrEP-AP Immediate Access who are enrolled as uninsured, minors, or clients with confidentiality concerns must receive services at approved locations within the PrEP-AP Provider Network. Clients enrolled in PrEP-AP Immediate Access as insured must recieve services through a provider in their health plan network. A Provider Referral Form for uninsured clients is not required for clients enrolled in PrEP-AP Temporary Coverage or PrEP-AP Immediate Access. Any medical service not on this list will not be reimbursable by PrEP-AP. Clients can access full PrEP-AP benefits by enrolling into PrEP-AP through a PrEP-AP Enrollment Worker at a PrEP-AP Enrollment Site.

Office Visit – Outpatient Service – Medication Administration

HIV Testing

Pregnancy Testing

Renal Function Testing

Hepatitis B Screening

Hepatitis C Screening