CommercialPrior AuthMedium impact
25-913 Bill Correctly for HIV Pre-exposure Prophylaxis (PrEP)
Health Net·CA · Family Medicine, Internal Medicine, Infectious Disease +1 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net California eliminated prior authorization requirements for FDA-approved HIV PrEP medications and all CDC-recommended integral services. Billing teams must use Z29.81 as the primary diagnosis code for all PrEP-related services to ensure proper coverage without cost-sharing.
Action Required
Immediately: Billing team must update system to always use Z29.81 as the primary diagnosis code for all HIV PrEP-related services and testing. Update encounter forms and EMR templates to remind providers. Do not submit prior authorization requests for FDA-approved PrEP medications. Ensure all CDC-recommended integral services are billed with Z29.81 to prevent patient cost-sharing charges.