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Billing guideline updated with HIV PrEP-related diagnosis code
September 29, 2023

This article is for providers discussing HIV PrEP with their patients
Please share with your billing department or billing agency

We have updated our Patient Protection and Affordable Care Act preventive care services billing guideline to reflect the latest ICD-10-CM diagnosis code (Z29.81) for encounters related to HIV pre-exposure prophylaxis (PrEP). Please refer to page 4. This is in effect for dates of service on and after October 1, 2023.

How does this affect our members, your patients?

When a preventive care visit includes discussion of HIV PrEP, the member may be eligible for this preventive care service at no additional cost as part of the Patient Protection and Affordable Care Act (ACA).

The diagnosis code should be billed in the primary position on the claim since our benefits for preventive, screening, counseling, or wellness services are based on the primary diagnosis. Taking this step helps avoid unnecessary claim denials and confusion for our members, so we suggest sharing this information with your billing department.

Thank you.

As always, before performing services, please check the member’s eligibility and benefits.