Coding for PrEP Management

[lhernandez@alphaidaho.org]

Has anyone had any luck using 99401 - 99404 for PrEP initiation and subsequent visits? If so, is modifier -33 necessary on the E/M or all CPT codes? My provider wants to use E/M 99212 and -33 modifier on all CPT codes (venipuncture and labs). Diagnosis codes would typically be a combination of Z29.81, Z11.3, Z20.2, Z20.6, Z79.899. Z11.59 and Z20.5. Any insight would be appreciated.

Lori Hernandez
Alpha Cares
Boise, ID

diagnosis codes, diagnosis coding

 

[jkyles]

Hi there, here is the MLN article from CMS that includes the appropriate encounter codes. https://www.cms.gov/files/document/...-exposure-prophylaxis-prep-hiv-prevention.pdf

As a general FYI, Medicare does not cover the preventive services E/M and it wouldn't make sense to automatically level an office/outpatient visit.

diagnosis codes, diagnosis coding