Summary & Overview

HCPCS Q0517: Pharmacy Supplying Fee for HIV Pre-Exposure Prophylaxis

HCPCS Level II code Q0517 designates a pharmacy supplying fee for FDA-approved, orally administered HIV pre-exposure prophylaxis (PrEP), billed per 60-day supply. This code clarifies a discrete pharmacy service component tied specifically to the dispensing of PrEP medications and is relevant to pharmacists, payers, and providers managing access to HIV prevention therapies at the point of dispensing. Nationally, clear coding for PrEP dispensing supports accurate claims processing, program monitoring, and patient access initiatives.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical and billing purpose, typical sites of service, and the service type. The publication also provides benchmark and coverage context where available, summarizes common modifier usage (input provided), and outlines areas where data was not provided. The material is intended to help billing managers, pharmacy directors, and policy analysts understand how Q0517 fits into claims workflows for PrEP medications and where gaps in published input data exist.

This summary is written for a national audience and focuses on code definition, operational context, and the types of insights covered in the full publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareQ0517HCPCS Level IIHIV PrEPPharmacy DispensingMedication SupplyOutpatient PharmacyPharmacy BillingHIV Prevention

Billing Code Overview

HCPCS Level II code Q0517 represents a pharmacy supplying fee for HIV pre-exposure prophylaxis (PrEP) for an FDA-approved prescription oral drug, billed per 60-day supply. The service type for this code is pharmacy dispensing / medication supply, and the typical site of service is retail or outpatient pharmacy that dispenses PrEP medications for HIV prevention.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 28-year-old sexually active cisgender man with multiple male partners presents to a community sexual health clinic seeking HIV pre-exposure prophylaxis (PrEP). The clinician performs a risk assessment, documents a negative HIV antigen/antibody test result, assesses renal function with serum creatinine and calculates estimated glomerular filtration rate (eGFR), screens for hepatitis B and sexually transmitted infections, provides counseling on adherence and risk reduction, and writes an FDA-approved oral PrEP prescription. The clinic pharmacy dispenses a 60-day supply and bills the pharmacy supplying fee using Q0517 for the medication supply service. Typical workflow steps include: initial clinical evaluation and testing, prescription generation, pharmacy dispensing of a 60-day supply, counseling and adherence aids provided by pharmacist, and follow-up visits with repeat HIV testing and periodic renal monitoring.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When additional pharmacist clinical effort beyond typical dispensing (extensive counseling, clinical coordination) is documented and billed by an eligible provider
`23`

Taxonomy Code	Specialty	Notes
`350400000X`	Clinical Pharmacist	Pharmacists dispensing PrEP and providing medication therapy management
`208000000X`	Family Medicine	Primary care providers who initiate PrEP prescriptions and coordinate dispensing
`207Q00000X`	Infectious Disease	Specialists managing complex HIV prevention and PrEP in high-risk patients
`363LP0800X`	HIV/AIDS Specialty Clinic	Clinic-based providers and staff focused on HIV prevention and PrEP services

ICD-10 Code	Description	Clinical Relevance
`Z20.6`	Contact with and (suspected) exposure to human immunodeficiency virus [HIV]	Indicates patient exposure risk and supports medical necessity for HIV PrEP dispensing billed with `Q0517`
`Z11.4`	Encounter for screening for human immunodeficiency virus [HIV]	Used when screening tests are performed at PrEP initiation and associated with pharmacy dispensing
`Z72.51`	High-risk heterosexual behavior	Documents behavioral risk factors that justify PrEP therapy and associated pharmacy supply
`Z72.52`	High-risk homosexual behavior	Documents sexual behavior risk supporting initiation and ongoing dispensing of PrEP
`Z79.899`	Other long term (current) drug therapy	May be used to indicate ongoing prophylactic medication therapy such as PrEP when dispensing recurring 60-day supplies
`R79.89`	Other specified abnormal findings of blood chemistry	Supports need for periodic monitoring (e.g., renal function) associated with safe PrEP dispensing
`Z91.19`	Patient's noncompliance with other medical treatment and regimen	Relevant for documenting adherence issues that affect dispensing decisions and counseling during the pharmacy supply of `Q0517`

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Frequently used for follow-up visits to assess adherence, side effects, and ongoing PrEP eligibility before pharmacy dispenses `Q0517`
`36415`	Collection of venous blood by venipuncture	Used to obtain blood for baseline and monitoring tests (HIV antigen/antibody, renal function) associated with PrEP initiation prior to dispensing a 60-day supply billed under `Q0517`
`87491`	Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique	Common STI screening performed at PrEP initiation or follow-up visits coordinated with the medication supply
`87389`	Infectious agent antigen detection by enzyme immunoassay, single step; hepatitis B surface antigen	Baseline hepatitis B screening performed before or at the time of PrEP dispensing
`81025`	Urine pregnancy test, by visual color comparison methods	Performed for patients of childbearing potential prior to initiating certain PrEP regimens and before dispensing a 60-day supply under `Q0517` if clinically indicated
`80061`	Lipid panel	Sometimes ordered at baseline or follow-up depending on comorbidities; relates to overall preventive care during PrEP management and coordination with pharmacy supply services provided under `Q0517`.

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