Step 1: Build Your PrEP Eligible List With EHR Reporting
Launching a PrEP program in an OB/GYN practice starts with one report, not a marketing campaign. The eligible list you pull from your EHR determines who gets called, how many schedulers you need, and whether outreach stays HIPAA-safe.
Which EHR Filters Actually Surface PrEP Candidates
Run one monthly report with these filters:
Recent STI positives: chlamydia, gonorrhea, syphilis, trichomoniasis
HPV diagnosis or abnormal cervical screening in the last 24 months
High-risk sexual health screening documented in the social history
Patients aged 15-64 with a preventive visit in the last 12 months
Prior HIV testing within the last year but no PrEP medication on file
That last filter matters most: patients already testing regularly are closest to saying yes.
Pro TipPull the report on the same day each month and save it to a shared folder. Schedulers work a stable callbook instead of chasing a moving target.
Step 2: Write PrEP Patient Outreach Scripts That Respect HIPAA
PrEP patient outreach scripts should never mention test results, diagnoses, or medication names on a call, voicemail, or text. Frame every contact as an invitation to a women's health prevention education program, the correct clinical approach, not a workaround.
Scripts that work share a simple structure:
Identify the practice and the caller by name
Invite the patient to a prevention education visit
Offer two specific appointment times
State that the visit is covered as preventive care
Give a callback number and a portal message option
PHI travels through the patient portal only. No exceptions.
Bilingual Execution for English, Spanish and Haitian Creole Patients
Miami-Dade and Broward clinics serve patients who prefer English, Spanish, or Haitian Creole. Scripts must exist in all three languages, written by native speakers, not machine-translated, and the voicemail greeting must match, or patients hang up.
Match the script language to the patient's preferred language in the EHR
Staff the scheduler phone lines with speakers of all three languages
Record voicemail greetings in each language
Test calls quarterly to confirm the routing works
Key TakeawayOutreach is an invitation, not a notification. If a script could embarrass a patient whose family overhears the voicemail, rewrite it.
Step 3: Design a Two-Step Visit Model That Starts Patients Same Day
The two-step visit model is the operational core of a PrEP program: a full telehealth session, then a lab stop at any office location with the fee waived.
Clinician discussing a PrEP program with a patient during a telehealth video call in a bright clinic office
Route the Patient to a Pathway Before the Visit, Not During It
Most practices lose same-day starts at the front desk, not the exam room. The pathway decision must be made at booking, when insurance is verified, so the prescriber knows what to order.
Commercial plan, generic oral available: default to generic oral PrEP; confirm the pharmacy benefit covers it before the visit
Commercial plan, brand-only formulary: route to brand oral; expect a prior authorization and start the paperwork at booking
Medicaid or uninsured: check the state PrEP assistance pathway and 340B pricing before quoting a copay
Patient prefers injectable: confirm the plan covers Apretude or Yeztugo and that the office can stock or order the drug before scheduling
What Has to Be True for a Same-Day Start
Same-day start is a checklist, not a hope. All five items have to be true before the patient leaves the lab stop:
Rapid HIV test resulted negative at rooming
Open lab order was placed during the telehealth session
Pathway and insurance were confirmed at booking
Drug is on hand (oral) or ordered and dated (injectable)
Next visit is booked before the patient walks out
Pro TipWaive the lab-stop fee to remove the biggest friction point. A patient who has to pay at the lab window is a patient who does not come back for the injection.
The Lab-Network Trap Nobody Warns You About
A preventive claim only pays at $0 cost-sharing when the lab is in-network. Send the HIV test and STI panel out-of-network and the patient gets a bill, the fastest way to lose a PrEP patient in month one.
Verify the reference lab is in-network for every plan you accept, not just the dominant one
Confirm the panel you order matches what the plan covers as preventive
Keep rapid test kits stocked at every location so rooming is never the bottleneck
Document the pathway choice in a structured field so the recall worklist can find it
Key TakeawaySame-day start is a routing problem, not a clinical one. Solve insurance and pathway at booking, and the visit itself becomes routine.
Step 4: Map Your Injectable PrEP Administration Workflow
Injectable PrEP administration workflow failures almost always trace to one root cause: the injection happened at an appointment never checked in. No encounter means no note, no charge, no revenue.
Task
Owner
Frequency
Verify insurance and pathway
Front desk
At booking
Check in the injection visit
Front desk
Day of visit
Document site, lot, exp, HIV result
MA or nurse
Day of visit
Place drug and admin codes on one claim
Billing
Within 48 hours
Confirm charge posted
Billing lead
Weekly
Step 5: Set Your PrEP Follow-Up Cadence and Recall Worklist
PrEP follow-up cadence is where most programs quietly lose patients. The intervals are fixed; the recall worklist is what keeps them.
Lapsed-injection follow-up needs a named owner and a weekly worklist. Automated reminders alone fail silently.
Scheduler: works the recall callbook, logs every attempt
MA or nurse: flags patients who no-show an injection
Prescriber: reviews open lab orders weekly and closes the loop
Program manager: reviews the overdue list every Monday
Step 6: Get PrEP Billing and Coding Right From the First Claim
Preventive coding decides whether PrEP pays. PrEP and its labs carry $0 cost-sharing under ACA section 2713 (USPSTF Grade A), but only when coded preventive and sent in-network.
The four failure points to check on every claim:
Coding: a diagnostic code turns a covered visit into patient responsibility
Lab network: out-of-network labs bill the patient directly
Panel scope: HSV, M. genitalium, and trichomoniasis sit outside the preventive mandate
Plan type: grandfathered plans, some Medicaid programs, and ERISA plans may not follow the mandate
Build the Billing Controls Into the EHR, Not a Spreadsheet
Most guides stop at the code list. The work that prevents denials happens in the EHR build.
Order set: a PrEP order set that pre-loads Z29.81, Z11.3 or Z11.4, the HIV test, the STI panel, and the renal function test so the prescriber cannot accidentally code diagnostic
Best-practice advisory: an alert that fires when a patient has a PrEP medication on the med list but no HIV test in 90 days
Structured result fields: lab results entered as discrete data, not scanned PDFs, so the overdue report can actually see them
Injection documentation template: site, lot number, expiration date, HIV result, and kit lot captured inside the encounter, not in a staff message
Charge-capture report: a weekly report that flags any injection administered without a matching charge
Patient-Facing Toolkit: What to Hand the Patient at Checkout
A toolkit is what makes counseling repeatable across every MA and every location.
One-page pathway sheet: generic oral, brand oral, and injectable side by side, with the visit cadence for each
Lab-stop card: where to go, what to bring, and a plain-language note that the visit is covered as preventive care
Next-visit card: the date, the location, and what labs will be drawn
Portal instructions: how to message the practice and where PHI will and will not travel
Bilingual versions: English, Spanish, and Haitian Creole, written by native speakers, not machine-translated
Watch OutAn injection given at a visit that was never checked in produces no encounter, no note, and no charge. The drug cost is absorbed with no reimbursement. Front-desk check-in is a billing control, not an administrative step.
The Legal and Scope Questions to Settle Before You Bill
Prescribing PrEP inside an OB/GYN scope is routine, but the medicolegal questions need answers on paper before the first claim goes out.
Confirm every prescriber on the roster is credentialed and listed under the correct rendering NPI, including mid-levels working under a supervising NPI
Confirm the practice's malpractice carrier covers PrEP prescribing and injectable administration
Confirm the standing order or protocol that lets MAs administer the injection is signed and current
Confirm the BAA covers every vendor that touches PHI, including the CRM and any texting platform
Key TakeawayBilling controls live in the EHR build and the checkout toolkit. If the order set, the alert, and the charge-capture report are not in place, no amount of staff training will close the leak.
Step 7: Review Weekly KPIs and Fix the Leaks
A PrEP program improves on a weekly review cycle, not a quarterly one. Small leaks compound fast when injections and labs are involved.
Track these numbers every week:
KPI
Target Signal
Fix If Off Track
Calls per scheduler per day
~30
Rebalance callbooks
Bookings per scheduler per day
~5
Rewrite scripts, retest languages
Same-day starts after negative rapid
High
Restock kits, simplify order set
No-show rate
Low and stable
Add reminders, offer telehealth
Overdue HIV tests
Shrinking
Assign a named recall owner
Injectable doses given but not billed
Zero
Audit check-in and charge posting
Frequently Asked Questions
What are the billing codes for PrEP in an OB/GYN setting?
Use Z29.81 for PrEP-related encounters and Z11.3 or Z11.4 for screening, never diagnostic codes, so the visit and labs stay preventive. For injectable cabotegravir, bill J0739 with administration code 96372 on the same claim. A CLIA-waived rapid HIV test can be billed with 86703 or 87389 QW under Z11.4. In our experience, the biggest billing failure is an injection given at an appointment that was never checked in, so no encounter or charge exists.
How do you identify PrEP candidates from an EHR?
Build a recurring monthly report from structured fields, not scanned documents. Filter for recent STI positives, HPV diagnoses, high-risk sexual history screening, and patients tested for HIV in the last 12 months. In programs we run, we've observed that a significant portion of the PrEP population can be overdue for an HIV test if scanned PDFs are used instead of structured lab results, as these are invisible to reports. Only structured lab results count, so fix the intake template before you pull the list.
What is the follow-up cadence for injectable PrEP?
Cabotegravir follows a month 1, month 2, then every 2 months schedule. Yeztugo uses a lead-in period and then dosing every 6 months. Oral PrEP needs a visit every 3 months with an HIV test and STI screen, plus renal function monitoring every 6 to 12 months. Book the next visit before the patient leaves the room, and assign a named owner to a weekly recall worklist, because automated reminders alone fail silently when a dose slips.
How do you maintain HIPAA compliance during PrEP outreach?
Frame every call, voicemail and text as an invitation to a women's health prevention education program, never tied to a test result or diagnosis. No test or diagnosis names on phone, voicemail or SMS, and PHI only through the patient portal. Use separate A2P 10DLC consent checkboxes for customer-care versus promotional texts, include STOP and HELP language, and keep a signed BAA with any vendor touching PHI. In our experience, script discipline is what keeps outreach defensible.
Bring us your patient acquisition, 340B program, or compliance bottleneck. We will show you what a 30-day launch looks like for your clinic — in English or Spanish, month to month, no long contract.
