CommercialCoverageMedium impact
PrEP Medication and Ancillary Services: Preventive Services Billing
CareFirst BlueCross BlueShield·Family Medicine, Internal Medicine, Infectious Disease +1 more·Pharmacy
Effective date
Feb 10, 2022
We identified it
Jun 20, 2026
Summary
CareFirst BlueCross BlueShield now covers PrEP medication (generic Truvada) and all associated monitoring services as preventive care with $0 cost-sharing, no prior authorization required. All HIV testing, hepatitis screening, kidney function tests, pregnancy testing, and counseling visits should be billed as preventive services.
Action Required
Immediately: Billing team must update coding protocols to submit all PrEP-related services as preventive screenings with $0 cost-sharing for CareFirst members. Use diagnostic codes Z113 or Z114 for creatinine/kidney function labs, and counseling codes 99401-99404 or preventive visit codes 99381-99387/99391-99397 for follow-up visits. Update encounter forms to remind providers that HIV, Hepatitis B/C, pregnancy testing, and kidney function monitoring should all be billed as preventive services.