MedicaidCoverageLow impact
Pharmacists Billing for HIV Pre- and Post-Exposure Prophylaxis Assessment and Consultation per Public Act 102-1051
Illinois Medicaid - HFS·IL · Pharmacy, Infectious Disease·Provider Notice
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
Illinois now allows pharmacists to bill Medicaid for HIV pre- and post-exposure prophylaxis assessment and consultation services at 85% of physician rates. Pharmacists must complete ACPE-accredited training, have physician standing orders, and update their Medicaid enrollment to bill specific CPT codes.
Action Required
For Illinois practices working with pharmacists providing HIV prophylaxis services: Pharmacists must complete ACPE-accredited training program and update IMPACT system enrollment by answering checklist question about training completion. Associate with a pharmacy as billing provider and ensure Category of Service 132 is added to Provider Information Sheet before submitting claims.