`Q0521` Supply fee hiv prep fda appr

Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction
Outpatient hospital: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction
DME supplier: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction

Medicare pricing for Q0521

Physician Fee Schedule (CY 2026, RVU26D)

Status X: statutory exclusion, not paid under the PFS.

Payer policies and prior authorization for Q0521

Payer coverage policies that name Q0521

Q0521 appears in 1 coverage policy from UnitedHealthcare.

Payer	Policy	Role in policy	Reviewed	Document
UnitedHealthcare	Preventive Care Services (MP.016.59) Pregnancy testing when \| G0011, G0013	listed, no stance	Jul 1, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

ND: $0.00 (physician), effective Aug 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

Q0521 Supply fee hiv prep fda appr