Physicians and qualified health professionals (QHP) can provide (get paid for) up to eight counseling sessions per year for HIV risk assessment, risk reduction and medication adherence, according to a national coverage determination (NCD) issued in 2024.

Background

On September 30, 2024 CMS issued a NCD 210.15, Pre-Exposure Prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV) Prevention, which shifts the provision of PrEP antiretroviral drugs to a Medicare Part B benefit (it was previously a Part D benefit). The NCD and related documents also outline the eligible services that providers can report, along with billable codes for counseling services and screening services.

CMS issued a series of explanatory documents that shed light on the coding and billing parameters contained within the NCD, including a frequently asked questions (FAQ) explainer.

The new preventive service and the billing codes became effective as of September 30, 2024.