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Overview

The HHS-wide initiative Ending the HIV Epidemic: A Plan for America seeks to leverage the powerful data and tools now available to reduce new HIV infections in the United States by 75 percent in five years and by 90 percent by 2030. HITEQ is identifying best practices and barriers to using health IT to support early diagnosis, application of proven prevention interventions including access to PrEP, and sustained treatment for people living with HIV to achieve and maintain viral suppression.

HIV Epidemic Resources
Billing and Coding for HIV Prevention: PrEP, Screening, and Linkage to Care
HITEQ Center

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.

 

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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.

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