Practice Implementation Center / HIV PEP/PrEP / Practice Administration / HIV PEP/PrEP Billing Codes and Appropriate Use

HIV PEP/PrEP Billing Codes and Appropriate Use

Overview

This guide provides an overview of the billing codes pharmacists can use for submitting claims related to HIV PEP/PrEP services, along with the relevant requirements and limitations. The resource clearly distinguishes between Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS) codes associated with HIV PEP/PrEP. Additionally, a “Tips for optimizing HIV PEP/PrEP billing” section offers strategies to optimize billing code usage for better reimbursement.

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Please note that since CPT codes are licensed by the American Medical Association (AMA), they are subject to a user license fee that APhA must pass on its member users. As such, this resource will require an additional fee for members.

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