Preventive Services
PrEP for HIV: Prepare for Potential Medicare Part B Coverage
On July 12, 2023, CMS proposed to transition coverage of Preexposure Prophylaxis (PrEP) using FDA-approved antiretroviral drugs (oral or injectable) to prevent HIV to Medicare Part B. Currently, HIV PrEP drugs may be covered under Medicare Part D.
It’s critical that your patients have uninterrupted access to their HIV PrEP drugs. We expect to release a final National Coverage Decision (NCD) in late September 2024, and we expect the final NCD will be similar to the proposed NCD. We’re encouraging you to prepare your systems now so you’re able to immediately transition to Part B coverage if we release a final NCD.
Review our fact sheet (PDF) and frequently asked questions (PDF) to learn more about how you can prepare for the possible upcoming coverage change, including information about enrollment, billing, claims processing, and coding.
Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep your patients from getting certain diseases. Talk to your patients about which preventive services are right for them and how often they need them.
If you’re a person with Medicare, learn about all preventive services.
Learn more about billing for Medicare-covered preventive services:
- Shots & vaccines
- COVID-19 vaccine toolkit
- Flu shot
- Hepatitis B shot
- Pneumococcal shot
- In-Home Vaccine Administration: Additional Payment
- Medicare Benefit Policy Manual – Chapter 15: Section 50.4.4.2 – Immunizations (PDF)
- Roster Billing: COVID-19, Flu, & Pneumococcal vaccines
- Skilled Nursing Facility: Billing Medicare for Respiratory Vaccines (PDF)
- Medicare Part D Vaccines (PDF)
- Wellness visits
- Diabetes-related services
- Tests & screenings
- Bone mass measurements
- Cardiovascular disease screening tests
- Cervical cancer screenings with Human Papillomavirus (HPV) tests
- Colorectal cancer screening tests
- Glaucoma screening
- Hepatitis B screening
- Hepatitis C screening
- HIV screening
- Lung cancer screening
- Mammography screening
- Pap tests screening
- Prolonged preventive services
- Prostate cancer screening
- Screening Pap Tests & Pelvic Exams (PDF)
- Screening pelvic exams, including clinical breast exam
- Sexually transmitted infection (STI) screening
- Ultrasound Abdominal Aortic Aneurysm (AAA) screening
- Counseling & therapies
- Mental health services
- Resources