CMS issued a final national coverage determination (NCD) stating that for claims with dates of service on or after Sept. 30 (the date CMS issued the NCD), pre-exposure prophylaxis (PrEP) using antiretroviral drugs to prevent HIV is covered as an additional preventive service, and is appropriate for individuals entitled to Medicare benefits under Part A or enrolled under Part B. CMS also covers furnishing HIV PrEP using antiretroviral drugs, including the supplying or dispensing of these drugs and the administration of injectable PrEP. CMS stated that payment and coding specifics will be addressed in the implementing instructions given to Medicare contractors.
For individuals being assessed for or using PrEP to prevent HIV, CMS covers all the following as an additional preventive service: a) Up to eight individual counseling visits every 12 months, that include HIV risk assessment (initial or continued assessment of risk), HIV risk reduction, and medication adherence (counseling must be furnished by a physician or other health care practitioner; individuals must be competent and alert at the time that counseling is provided); b) Up to eight HIV screening tests every 12 months; and c) A single screening for hepatitis B virus.
In response to concerns from NCPA and others about administrative burden that the transition from Part D to Part B coverage would entail, CMS stated that it published a webpage containing additional resources, hosted office hours, and encouraged ....
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