Billing/Coding Guide for HIV Prevention

Updated: December 8, 2016

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Published by: NASTAD (www.NASTAD.org)

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. Services are provided in traditional health care 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.