Traditional MedicareCoverageMedium impact
Pre-Exposure Prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV) Prevention
Medicare/CMS - NCD·Family Medicine, Internal Medicine, Infectious Disease·National Coverage Determination
Effective date
Apr 7, 2026
We identified it
Jun 17, 2026
Summary
Medicare has issued a new National Coverage Determination (NCD 210.15) for Pre-Exposure Prophylaxis (PrEP) for HIV Prevention. This establishes coverage criteria and billing guidelines for PrEP services under Medicare, which may affect primary care and infectious disease practices that provide HIV prevention services.
Action Required
By April 7, 2026: Billing teams at practices providing PrEP services should review the complete NCD 210.15 policy document to understand Medicare coverage criteria, documentation requirements, and any billing restrictions for HIV prevention services. Update billing procedures and provider documentation templates accordingly to ensure compliance with the new coverage determination.