{"id":8413,"date":"2023-11-01T13:56:28","date_gmt":"2023-11-01T13:56:28","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=8413"},"modified":"2023-11-01T13:56:28","modified_gmt":"2023-11-01T13:56:28","slug":"hiv-prep-preventive-health-service-coverage","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/hiv-prep-preventive-health-service-coverage\/","title":{"rendered":"HIV PrEP Preventive Health Service Coverage"},"content":{"rendered":"<p>Back in 2021, with the release of the Division of Insurance Bulletin 2021-09, Health New England aligned our systems to look for the appropriate service codes and diagnosis related to PrEP (Pre-exposure prophylaxis) and respond as preventative care.<\/p>\n<p><em><strong>Once again, with the release of the new ICD diagnosis code Z29.81, we have added it to our systems under the same grouping. Some of the groupings referenced include, but are not limited to:<\/strong><\/em><\/p>\n<ul>\n<li>Preventive Counseling: 99401 \u2013 99404, 99406-99408<\/li>\n<li>Evaluation and Management Services Related to HIV: 99211-99212<\/li>\n<li>Pregnancy Testing: 81025, 84703<\/li>\n<li>Kidney Function: 82565, 82570, 82575, 82610<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>In addition, the <em><strong>Health Care Reform Copay Waiver Request Form<\/strong><\/em> is available on Optum.com (<a href=\"https:\/\/professionals.optumrx.com\/prior-authorization\/prior-authorization-lob.html\" target=\"_blank\" rel=\"noopener\">OptumRx Prior Authorization- Lines of Business<\/a>). For consideration of a $0 cost share for primary prevention, we recommend providers fill this form out. Optum, on behalf of Health New England, will use the PrEP criteria and review your request.<\/p>\n<p>For more information, please do not hesitate to call your Provider Relations Representative at (800) 842-4464, extension 5000, or send an email to <a href=\"mailto:providerrelations@hne.com\">providerrelations@hne.com<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Back in 2021, with the release of the Division of Insurance Bulletin 2021-09, Health New England aligned our systems to look for the appropriate service codes and diagnosis related to PrEP (Pre-exposure prophylaxis) and respond as preventative care. Once again, with the release of the new ICD diagnosis code Z29.81, we have added it to [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[92],"tags":[],"class_list":["post-8413","post","type-post","status-publish","format-standard","hentry","category-provider-newsletter"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-2bH","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8413","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/comments?post=8413"}],"version-history":[{"count":2,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8413\/revisions"}],"predecessor-version":[{"id":8420,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8413\/revisions\/8420"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8413"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8413"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8413"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}