Preventive Coverage Update of Combined Chlamydia and Gonorrhea Testing for Commercial Members for the work-up and follow-up for pre-exposure prophylaxis for the prevention of HIV (Effective 07/01/2026)

By June 30, 2026: Billing team must update billing system to recognize combined Chlamydia and Gonorrhea testing as preventive coverage (no patient cost-sharing) for commercial members when billed in conjunction with PrEP work-up or follow-up visits. Update encounter documentation templates to require providers to link these tests to PrEP-related visits to ensure proper preventive coding classification. Train billing staff to distinguish between preventive screening (covered at 100%) versus diagnostic testing (subject to plan benefits). Failure to properly classify as preventive may result in incorrect patient billing or claim denials. Verify applicable CPT/HCPCS codes with the payer directly as none were specified in the policy announcement.