Need Assistance?
Would you like more assistance regarding Health IT Enabled QI strategies or support in using any of the included resource sets?

  Request Support

 

Upcoming Events
The Quadruple Aim
Quadruple Aim

A Conceptual Framework

Improving the U.S. health care system requires four aims: improving the experience of care, improving the health of populations, reducing per capita costs and improving care team well-being. HITEQ Center resources seek to provide content and direction aligned with the goals of the Quadruple Aim

Learn More >

Accessing Data for QI

As adoption of EHRs has increased, so have the concerns about ability to access the data needed to drill down into quality improvement efforts or even reporting requirements. Depending on the type of system being used, data may be cloud based, on a remote server, or on a local server. Further, data may be accessible through preprogrammed, ad hoc, or custom reports, but there may be greater challenges to accessing raw data or data that can be analyzed for quality improvement purposes. Resources in this section address these challenges and provide actionable information for accessing the data needed.

Accessing your Data
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.

Print
16390
Tags: GuideBillingcodingHIVPrEPEnding the HIV EpidemicHIV screeningHIV prevention

Resource Links

Related Resources

Acknowledgements

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