FLASH: PrEP Therapy
August 18, 2021Health Alliance will cover HIV Preexposure Prophylaxis (PrEP) and related recommended testing beginning on August 18, 2021. This will apply to all Health Alliance plans. Recommended testing is consistent with CDC guidelines and includes:
1. HIV Testing – Members must not be HIV infected to be able to start PrEP therapy. In addition, members must be tested every 3 months while in PrEP therapy. If a patient becomes HIV positive during PrEP, the therapy should be stopped to halt drug resistance.
Acceptable codes for this test include: 36415, 80081, 86689, 86701, 86702, 86703, 87534, 87535, 87536, 87537, 87538, 87539, 87389, 87390, 87391, 87806, G0432, G0433, G0435, G0475, and S3645
2. Hepatitis B and C Testing – Providers must perform these tests prior to starting PrEP to see the baseline for liver function and the possibility of developing Hepatitis C during PrEP. This needs to be monitored in particular after PrEP is concluded to make sure liver function returns to normal.
Acceptable codes for these tests include: 81596, 87516, 87517, 87520, 87521, 87522, 87340, 87341, 87350, 87380, 87901, 87902, 87906, 87910, 87912, 86803, G0472, and G0499
3. Creatinine Testing – Creatinine testing is required to assess kidney function before the start of PrEP. Creatinine testing is required during PrEP therapy as well.
Acceptable codes for this test include: 82565, 82570, 82575, 0602T, 0603T, Z20.2, and Z20.6
4. Pregnancy Testing – Appropriate members will need to be tested for pregnancy before beginning PrEP and during therapy so the patient can make an informed decision about the therapy and impact to both the mother and the child.
Acceptable codes for this test include: 81025, 84702, and 84703
5. Sexually Transmitted Infection Screening – Persons taking PrEP must be screened for a baseline and then again periodically thereafter.
6. Adherence Counseling – Counseling is required during PrEP to ensure adherence to the prescribed medication and to maximize PrEP’s effectiveness.