News
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 encourage you to prepare your systems now so you’re able to immediately transition to Part B coverage if we release a final National Coverage Decision.
Review our fact sheet (PDF) to learn more about how you can prepare for the possible upcoming coverage change, including information about enrollment, billing, claims processing, and coding.
Events
Clinical Laboratory Fee Schedule Upcoming Meetings: Register to Present, Speak, or Attend in Person by June 1
Learn about opportunities at these upcoming meetings:
- June 25 – Annual Public Meeting Regarding New and Reconsidered Clinical Diagnostic Laboratory Test Codes for CY 2025: Register to present or to attend in person by June 1
- July 25–26 – Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests: Register as a standby speaker or to attend in person by June 1
You don’t need to register to view or listen to the meeting virtually.
Publications
Medicare Preventive Services — Revised
Learn what’s changed:
- Annual wellness visit: clarified social determinants of health information
- Bone mass measurement: added a link to the most current and comprehensive list of ICD-10 codes
- Colorectal cancer screening: added a link to the most current and comprehensive list of ICD-10 codes
- COVID-19 vaccine and administration: added coding, coverage, and payment information
- Sexually transmitted infection (STI) screening & high intensity behavioral counseling to prevent STIs: replaced Hepatitis B information with a link to the Hepatitis B screening service
Original Medicare vs. Medicare Advantage — Revised
Learn what’s changed (PDF). CMS updated payment rules for patients enrolled in Medicare Advantage Organizations.
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