Billing and Coding for HIV Prevention: PrEP, Screening, and Linkage to Care

Developed by NASTAD, updated in 2018

As part of the Centers for Disease Control and Prevention (CDC) Capacity Building Assistance (CBA) cooperative agreement, National Alliance of State & Territorial AIDS Directors (NASTAD) released a Billing Coding Guide for HIV Prevention: PrEP, Screening, and Linkage Services. The guide, developed in collaboration with a coding consultant and the HIV Medicine Association, was updated in 2018. It assists health departments and other providers (such as health centers!) to navigate billing and reimbursement for HIV prevention services. 

This guide was originally created by NASTAD because, while some of the services are provided in traditional healthcare settings and can be billed to public and private insurance, some of HIV prevention services may be provided in non-traditional settings and/or by non-licensed professionals making it a challenge to bill insurance for these services. The counseling services needed for the treatment and discussion of lab tests are intensive. While some of the services are provided in traditional healthcare settings and can be billed to public and private insurance, some of these services are provided in non-traditional settings by non-licensed professionals making it a challenge to bill insurance for these services. This guide describes the procedure and diagnosis codes that are accepted by public and private insurance, along with specific requirements for some Current Procedural Terminology (CPT®) billing codes. It also describes some of the challenges in obtaining reimbursement for testing, counseling, linkage to care and adherence services.