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PrEP Provider Toolkit

PrEP Initiation

Coding for PrEP Visits

   Below are the recommended visit codes for PrEP management.
This may vary based on your institution.

  • Z20.6Z20.6 (Contact with and (suspected) exposure to HIV)
  • Z79.899 (Other long term drug therapy) If PrEP is started or continued

and at least one of the following:

  • Z72.5 (high risk sexual behavior) if there are sexual risk factors
  • W46.1XXD (contact with contaminated hypodermic needle) if there are IVDU risk factors

Billing:

  • If PrEP is the only topic addressed
    • 99401 approximately 15 minutes
    • 99402 approximately 30 minutes
    • 99403 approximately 45 minutes
    • 99404 approximately 60 minutes
  • If multiple health topics are addressed, use normal billing codes based on complexity (e.g. 99213, 99214)