Z29.81 — Encounter for HIV pre-exposure prophylaxis
Is Z29.81 billable?
Yes — Z29.81 is billable for FY2027. Z29.81 is a valid, billable ICD-10-CM code at the highest level of specificity in its branch. Z29.81 may be submitted for encounters from October 1, 2026 through September 30, 2027.
Z29.81 at a glance
| Code | Z29.81 |
|---|---|
| Description | Encounter for HIV pre-exposure prophylaxis |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
What Medicare edits apply to Z29.81?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name Z29.81 directly.
CMS will reject this code as the principal diagnosis on an inpatient claim. It describes something other than the condition chiefly responsible for the admission.
Which MS-DRGs does Z29.81 group to?
Z29.81 sits in MDC 23 and helps define the logic of 1 MS-DRG (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 951Other Factors Influencing Health Statusmedical
How is Z29.81 listed in the Alphabetic Index?
These are the routes through the Alphabetic Index that lead to Z29.81. They show the wording a clinician may have documented, which often differs from the Tabular description.
- Encounter › HIV › pre-exposure prophylaxis (with health service) (for)
- Encounter › HIV › PrEP (with health service) (for)
- Encounter › prophylactic measures › HIV pre-exposure (with health service) (for)
Code also
Two codes may be needed to describe the condition fully. Whether Z29.81 is sequenced first depends on the reason for the encounter.
Excludes1 — never code together — inherited from Z29
The conditions below can never be reported together with Z29.81 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
How long has Z29.81 existed?
Z29.81 first appears in FY2024.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.