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Allowable Pre-Exposure Prophylaxis (PrEP) Related Medical Services

Effective October 18, 2022

The California Department of Public Health, Office of AIDS (OA), PrEP Assistance Program (PrEP-AP) provides assistance with medical out-of-pocket costs for clients 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 Provider Network to provide services to uninsured clients. Uninsured clients must receive services at approved locations within the PrEP-AP Provider Network. Clients with insurance will have the actual portion of their co-payment obligation charged by the insurance plan paid for by the PrEP-AP.

Office Visit – Outpatient Service – Medication Administration

CPT Codes Description CDPH Reimbursement Rate
99202
 New Patient Office or Other Outpatient Service (20 minutes)
 $74.06
99203 New Patient Office or Other Outpatient Service (30 minutes) $113.85
99204 New Patient Office or Other Outpatient Service (45 minutes) $169.57
99205 New Patient Office or Other Outpatient Service (60 minutes) $224.25
99211 Established Patient Office or Other Outpatient Service (5 minutes) $23.53
99212 Established Patient Office or Other Outpatient Service (10 minutes) $57.45
99213 Established Patient Office or Other Outpatient Service (15 minutes) $92.05
99214 Established Patient Office or Other Outpatient Service (25 minutes) $129.77
99215 Established Patient Office or Other Outpatient Service (40 minutes) $183.07
90471 Immunization Administration  $16.96
96372
 Therapeutic, Prophylactic, & Diagnostic Injections and Infusions $14.54
​96373
 ​Therapeutic, Prophylactic, & Diagnostic Injections and Infusions
 ​$18.34
​99421
 ​Online Digital Evaluation and Management Service (5-10 minutes)
 ​$15.23
​99422
 ​Online Digital Evaluation and Management Service (11-20 minutes)
 ​$29.76
​99423
 ​Online Digital Evaluation and Management Service (21 or more minutes)
 ​$48.45
​99441
 ​Audio-only (Telephone) Evaluation and Management Service (5-10 minutes)
 ​$56.75
​99442
 ​Audio-only (Telephone) Evaluation and Management Service (11-20 minutes)
 ​$91.71
​99443
 ​Audio-only (Telephone) Evaluation and Management Service (21-30 minutes)
 ​$129.77
​98970
 ​Qualified Nonphysician Health Care Professional Online Digital Evaluation and Management Service (5-10 minutes)
 ​$11.77
​98971
 ​​Qualified Nonphysician Health Care Professional Online Digital Evaluation and Management Service (11-20 minutes)
 $20.79
​98972
 ​Qualified Nonphysician Health Care Professional Online Digital Evaluation and Management Service (21-30 minutes)
 ​​$32.18
​G2012
 ​Brief Communication Technology-based Service (5-10 minutes)
 ​$14.54
​G2010
 ​Remote Evaluation of Recorded Video and/or Images Submitted by an Established Patient
 ​$12.11
​G2250
 ​Remote Evaluation of Recorded Video and/or Images Submitted by an Established Patient
 ​$12.11
​G2251
 ​Brief Communication Technology-based Service (5-10 minutes)
 ​$14.54
G2252
 Brief Communication Technology-based Service (11-20 minutes)
 $28.03

HIV Testing

CPT Codes Description CDPH Reimbursement Rate
​85025
 ​Complete Blood Cell Count (red cells, white blood cells, platelets), Automated
 ​$7.77
​85026
 ​Complete Blood Cell Count (red cells, white blood cells, platelets), Automated
 ​$7.77
​85027
 ​Complete Blood Cell Count (red cells, white blood cells, platelets), Automated
 ​$6.47
86359 CD4 Cell Count $37.73
86689 HTLV/HIV Confirmatory Test $19.35
86701 HIV-1 $8.89
86702 HIV-2 $13.52
86703 HIV-1/HIV-2, Type Diffrentiating  Assay (Bio Rad Geenius) $13.71
87389 HIV-1/2 Antigen and Antibodies, Fourth Generation with Reflexes $24.08
87390 HIV-1 AG, EIA $24.06
87391 HIV-2 AG, EIA $21.90
87534 HIV-1, DNA, DIR Probe $21.92
87535 HIV-1, RNA, Qualitative, PCR $35.09
87536 HIV-1, Viral Load (RNA, Quant) $85.10
87537 HIV-2, DNA, DIR Probe $21.92
87538 HIV-2, DNA, AMP Probe $35.09
87539 HIV-2, DNA, Quant
 $58.62
​87806
 ​HIV-1 Antigen and Antibodies, with HIV 1/2 Atibodies
 ​$32.77
87900 HIV-1 Drug Resistance Assay - Phenotype Prediction Using Genotype Bioinformatics
 $130.35
87901 HIV-1 Drug Resistance Assay - Protease and Reverse Trascriptase Genotype  $257.45
87906 HIV-1 Drug Resistance Assay - Integrase Genotype 
 $128.73

STI Testing

​CPT Code
 Description​ CDPH Reimbursement Rate​
​86592
 ​Blood Serology, Qualitative (Including Non-Treponemal Syphilis Tests (RPR, VRDL)
 ​$4.27
​86593
 ​Blood Serology, Quantitative (Including RPR and VRDL Titers)
 ​$4.40
​86780
 ​Syphilis Immunoassays (Including T. Pallidum Antibody and the TPPA Assay)
 ​$13.24
​87070
 ​Culture, Bacteria, Other
 $8.62​
​87081
 ​Culture
 ​$6.63
​87110
 ​Chlamydia, Culture
 ​$19.60
​87164
 ​Dark Field without Specimen Collection
 $10.74​
​87166
 ​Dark Field with Specimen Collection
 $11.30​
​87205
 ​Smear Gram Stain
 $4.27​
​87270
 ​​Chlamydia Trachomatis AG, IF
 ​$11.98
​87285
 Treponem Pallidum AG, IF
 $12.18​
​87320
 ​Chlamydia Trachomatis AG, EIA
 ​$15.00
​87490
 ​​Chlamydia Trach, DNA DIR Probe
 $22.75​
​87491
 ​Chlamydia Trach, DNA AMP Probe
 ​$35.09
​87492
 ​Chlamydia DNA or RNA, Quant
 ​$53.47
​87590
 ​N. Gonorrhoeae, DNA, DIR Probe
 $26.88​
​87591
 ​N. Gonorrhoeae, DNA, AMP Probe
 $35.09​
​87592
 ​N. Gonorrhoeae, DNA, Quant
 ​$42.84
​87593
 Orthopoxvirus (e.g., MPX virus, cowpox virus, vaccinia virus), DNA or RNA AMP Probe
 ​$35.09
​87800
 ​Smear Gram Stain
 $43.67​
​87801
 ​Multiple Organism NAAT
 $70.20​

Pregnancy Testing

​CPT Code
 Description​ CDPH Reimbursement Rate​
​81025
 ​hCG, Qualitative, Urine
 ​$8.61
​84702
 ​hCG Beta Subunit, Total, Quantitative, Serum
 ​$15.05
​84703
 ​hCG Beta Subunit, Qualitative
 ​$7.52
​84704
 ​hCG Free Beta Chain Test
 ​$15.29

Renal Function Testing

​CPT Code
 Description​
 CDPH Reimbursement Rate​
​80053
 ​Comprehensive Metabolic Panel
 ​$10.56
​82565​
 ​Creatinine, Blood
 ​$5.12
​82570
 ​Creatinine, Blood
 ​$5.18
82575
 ​Creatinine, Blood
 ​$9.46

Hepatitis A Screening

​CPT Code
 Description​
 CDPH Reimbursement Rate​
​86708
 HAV AB​
 $12.39​

Hepatitis B Screening

​CPT Code
 ​Description
 ​CDPH Reimbursement Rate
​80074
 ​Acute Hepatitis Panel
 $47.63​
​86705
 ​Hepatitis B Core Antibody (IGM) Measurement
 ​$11.77
​86706
 ​HBV Surface AB
 ​$10.74
​87340
 Hepatitis B Surface AG, EIA
 $10.33​
​87341
 ​Hepatitis B Surface AG, Immunoassay
 $10.33​
​87350
 ​Detection Test by Immunoassay
 ​$11.53
​86704
 ​HBV Core AB
 $12.05​

Hepatitis C Screening

​CPT Code
 ​Description
 ​CDPH Reimbursement Rate
​86803
 ​Hepatitis C AB Test
 ​$14.27
​86804
 ​Hepatitis C AB Test,  Confirm
 ​$15.49
​87522
 ​Hepatitis C Viral RNA, Quantitive, Real-Time PCR
 ​$42.84

Liver Function Test

​CPT Code
 ​Description
 ​CDPH Reimbursement Rate
​84460
 ​Transferase Alanine Amino ALT SGPT
 ​$5.30

Cholesterol and Triglyceride Screening

​CPT Code
 ​Description
 ​CDPH Reimbursement Rate
​80061
 ​Lipid Panel
 ​$13.39
​82465
 ​Cholesterol, Total
 ​$4.35
​83718
 ​Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)
 ​$8.19
​83719
 ​Lipoprotein, direct measurement; very low density cholesterol (VLDL cholesterol)
 ​$12.75
​83721
 ​Lipoprotein, direct measurement; low density cholesterol (LDL cholesterol)
 ​$10.50
​84478
 Triglycerides
 ​$14.27

Other

​CPT Code
 ​Description
 ​CDPH Reimbursement Rate
​36415
 ​Collection Venous Blood Venipuncture
 ​​$3.00
​81001
 ​​Urinalysis; automated, with microscopy
 $3.17

PrEP Related ICD-10 Codes

​ICD-10 CODE
 ​DESCRIPTION
​Z71.7
 ​Encounter for HIV Counseling
​Z72.5
 ​High-Risk Sexual Behavior
​Z72.51
 ​High-Risk Heterosexual Behavior
​Z72.52
 ​High-Risk Homosexual Behavior
​Z72.53
 ​High-Risk Bisexual Behavior
​Z20
 ​Contact with and (Suspected) Exposure to Communicable Disease
​Z20.2
 ​Contact with and (Suspected) Exposure to Infections with a Predominantly Sexual Mode of Transmission
​Z20.5
 ​Contact with and (Suspected) Exposure to Viral Hepatitis
​Z20.6
 ​Contact with and (Suspected) Exposure to Human Immunodeficiency Virus (HIV)
​Z20.8
 ​Contact with and (Suspected) Exposure to Other Communicable Diseases
​Z20.82
 ​Contact with and (Suspected) Exposure to Other Viral Communicable Diseases
​Z20.81
 ​Contact with and (Suspected) Exposure to Other Bacterial Communicable Diseases
​Z20.9
 ​Contact with and (Suspected) Exposure to Unspecified Communicable Diseases
Z29.8​
 ​Other Specified Prophylactic Measures
​Z771.21
 ​Contact with and (Suspected) Exposure to Potentially Hazardous Body Fluids
​W46.0XXA
 ​Contact with Hypodermic Needle (Initial Encounter)
​W46.0XXD
 ​Contact with Hypodermic Needle (Subsequent Encounter)
​W46.1XXA
 ​Contact with Contaminated Hypodermic Needle (Initial Encounter)
​W46.1XXD
 ​Contact with Contaminated Hypodermic Needle (Subsequent Encounter)
Z11.59
 ​Encounter for Other Viral Diseases
​Z70.0
 ​Counseling Realted to Sexual Attitude
Z70.1
 ​Counseling Related to Patients Sexual Behavior and Orientation 
Z11.4
 ​Encounter for Screening for Human Immunodeficiency Virus (HIV)
​Z11.3
 ​Encounter for Screening for Infections with a Predominantly Sexual Mose of Transmission
​Z01.812
 ​​Encounter for Preprocedural Laboratory Examination
​Z51.81 
 ​Encounter for Therapeutic Drug Level Monitoring
Z79.899
 Other Long Term (Current) Drug Therapy

​Clinically Administered Medications 
​Reach out to PrEP.Support@cdph.ca.gov to request the PrEP-AP Allowable Clinically Administered Medications list.


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