In October 2024, Medicare coverage for HIV PrEP moved from Medicare Part D to Part B, while HIV treatment remained covered by Part D. The initial billing guidance included a handful of HCPCS codes for pharmacies to claim a supplying fee in addition to drug reimbursement. In an updated FAQ, CMS instructs pharmacies, beginning Jan. 1, 2025, to use a single HCPCS code, Q0152, for supplying HIV PrEP. Review this and other FAQ on Part B HIV PrEP coverage at https://www.cms.gov/medicare/coverage/prep.
NCPA
