Skip to Main Content

Print | Bookmark | | Font Size: + |

January 14, 2024

PrEP Fee Amount and New Supply Code for 2025

Starting September 30, 2024, CMS covers pre-exposure prophylaxis (PrEP) using antiretroviral drugs approved by the FDA to prevent HIV in individuals at increased risk for contracting HIV.

Effective January 1, 2025, the new supply fee HCPCS Q0521 will replace all existing supply fee HCPCS codes Q0516 - Q0520.

HCPCS Code Description Fee
Q0521 PHARMACY SUPPLYING FEE FOR HIV PRE-EXPOSURE PROPHYLAXIS FDA APPROVED PRESCRIPTION $24.00

Here are the HIV PrEP HCPCS codes and pharmacy supply fee amounts for September 30, 2024 – December 31, 2024:

HCPCS Code Description Fee
J0750 EMTRICITABINE 200MG AND TENOFOVIR DISOPROXIL FUMARATE 300MG, ORAL,FDA APPROVED PRESCRIPTION, ONLY FOR USE AS HIV PRE-EXPOSURE PROPHYLAXIS (NOT FOR USE AS TREATMENT OF HIV) $1.062
J0751 EMTRICITABINE 200MG AND TENOFOVIR ALAFENAMIDE 25MG, ORAL, FDA APPROVED PRESCRIPTION, ONLY FOR USE AS HIV PRE-EXPOSURE PROPHYLAXIS (NOT FOR USE AS TREATMENT OF HIV) $75.612
Q0516 PHARMACY SUPPLYING FEE FOR HIV PRE-EXPOSURE PROPHYLAXIS FDA APPROVED PRESCRIPTION ORAL DRUG, PER 30-DAYS $24.00
Q0517 PHARMACY SUPPLYING FEE FOR HIV PRE-EXPOSURE PROPHYLAXIS FDA APPROVED PRESCRIPTION ORAL DRUG, PER 60-DAYS $40.00
Q0518 PHARMACY SUPPLYING FEE FOR HIV PRE-EXPOSURE PROPHYLAXIS FDA APPROVED PRESCRIPTION ORAL DRUG, PER 90-DAYS $56.00
Q0519 PHARMACY SUPPLYING FEE FOR HIV PRE-EXPOSURE PROPHYLAXIS FDA APPROVED PRESCRIPTION INJECTABLE DRUG, PER 30-DAYS $24.00
Q0520 PHARMACY SUPPLYING FEE FOR HIV PRE-EXPOSURE PROPHYLAXIS FDA APPROVED PRESCRIPTION INJECTABLE DRUG, PER 60-DAYS $24.00

For more information, see the National Coverage Determination (NCD)External Website and CMS PrEP for HIV & Related Preventive ServicesExternal Website.

Publication History
October 8, 2024 Original publication date
January 14, 2025 We added the new fee and supply code effective January 1, 2025.

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved