October 8, 2024
PrEP Fee Amounts
Starting September 30, 2024, CMS covers pre-exposure prophylaxis (PrEP) using antiretroviral drugs approved by the FDA to prevent HIV in individuals at increased risk for contracting HIV.
Here are the HIV PrEP HCPCS codes and pharmacy supply fee amounts:
HCPCS Code | Description | Fee |
---|---|---|
J0750 | EMTRICITABINE 200MG AND TENOFOVIR DISOPROXIL FUMARATE 300MG, ORAL,FDA APPROVED PRESCRIPTION, ONLY FOR USE AS HIV PRE-EXPOSURE PROPHYLAXIS (NOT FOR USE AS TREATMENT OF HIV) | $1.062 |
J0751 | EMTRICITABINE 200MG AND TENOFOVIR ALAFENAMIDE 25MG, ORAL, FDA APPROVED PRESCRIPTION, ONLY FOR USE AS HIV PRE-EXPOSURE PROPHYLAXIS (NOT FOR USE AS TREATMENT OF HIV) | $75.612 |
Q0516 | PHARMACY SUPPLYING FEE FOR HIV PRE-EXPOSURE PROPHYLAXIS FDA APPROVED PRESCRIPTION ORAL DRUG, PER 30-DAYS | $24.00 |
Q0517 | PHARMACY SUPPLYING FEE FOR HIV PRE-EXPOSURE PROPHYLAXIS FDA APPROVED PRESCRIPTION ORAL DRUG, PER 60-DAYS | $40.00 |
Q0518 | PHARMACY SUPPLYING FEE FOR HIV PRE-EXPOSURE PROPHYLAXIS FDA APPROVED PRESCRIPTION ORAL DRUG, PER 90-DAYS | $56.00 |
Q0519 | PHARMACY SUPPLYING FEE FOR HIV PRE-EXPOSURE PROPHYLAXIS FDA APPROVED PRESCRIPTION INJECTABLE DRUG, PER 30-DAYS | $24.00 |
Q0520 | PHARMACY SUPPLYING FEE FOR HIV PRE-EXPOSURE PROPHYLAXIS FDA APPROVED PRESCRIPTION INJECTABLE DRUG, PER 60-DAYS | $24.00 |
For more information, see the National Coverage Determination (NCD) and CMS PrEP for HIV & Related Preventive Services.