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Overview

This section provides guidance to understand the key contract terms involved in negotiating the vendor contract. It is critical to negotiate a vendor contract that takes into account the unique circumstances of your center and incorporates flexibility to meet your reporting needs. Guidance is offered related to indemnification, warranties and disclaimers, liability, dispute resolution, termination and migration, and access to and use of the EHR data.  
Purchasing EHR
Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and Other HIV Prevention Strategies: Billing and Coding Guide
HITEQ Center
/ Categories: Priority Topics, Ending the HIV Epidemic, HIV, PrEP

Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and Other HIV Prevention Strategies: Billing and Coding Guide

Developed by NASTAD, updated in 2023

Health departments and other medical providers are billing Medicaid, Medicare, and private insurers for services related to HIV prevention. The counseling services needed for the treatment and discussion of lab tests are intensive. 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.

The goal of this guide is to provide up-to-date information and best practices for coding, billing, and denial resolution for PrEP and PEP services. Health department staff are encouraged to share this resource with grantees, community partners, and other health care providers billing for HIV prevention services.

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Tags: GuideBillingcodingHIVPrEPEnding the HIV EpidemicHIV screeningHIV prevention

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Acknowledgements

This resource collection was compiled by the HITEQ Center staff with guidance from HITEQ Advisory Committee members and collaborators of the HITEQ Center.