HCPCS G0011: PrEP counselingMedicare rate & RVUs
Report G0011 when a physician spends 15–30 minutes counseling a patient about HIV preexposure prophylaxis and reducing HIV acquisition risk.
Medicare pays $29.39 for G0011 nationally in the office and $21.71 in a hospital or facility. Local office rates run $26.91–$37.15.
Medicare rate · G0011
PrEP counseling
Swap in your local Medicare rate.
- Work RVUs
- 0.45
- Total RVUs
- 0.88
- Global days
- XXX
National rate · 2026
$29.39
Office setting, before claim adjustments.
See every locality for G0011 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
What G0011 covers
A physician uses this service to counsel a patient about HIV preexposure prophylaxis (PrEP), including whether PrEP may fit the patient’s prevention needs, medication options, adherence, and risk-reduction strategies. It is relevant when a patient who may benefit from PrEP is considering it or needs counseling while using it. The service is typically furnished in an outpatient setting, such as a physician’s office.
Report G0011 for the physician’s 15–30 minutes of PrEP counseling, not for the medication injection itself. The record should identify the prevention counseling provided, the physician furnishing it, and the time spent. When an HIV PrEP injection is also given, G0012 represents that injection service; document each service performed. Use G0013 when the qualifying counseling is furnished by clinical staff rather than the physician.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where G0011 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$26.91 to $37.15
109 of 109 payment localities
G0011 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$26.91
$37.15
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $37.15 | 1 |
| AL | $27.18 | 1 |
| AR | $26.91 | 1 |
| AZ | $28.80 | 1 |
| CA | $30.28–$36.18 | 29 |
| CO | $30.11 | 1 |
| CT | $30.98 | 1 |
| DC | $32.67 | 1 |
| DE | $29.18 | 1 |
| FL | $29.49–$31.97 | 3 |
| GA | $28.24–$29.91 | 2 |
| GU | $30.61 | 1 |
| HI | $30.61 | 1 |
| IA | $27.48 | 1 |
| ID | $27.65 | 1 |
| IL | $29.01–$31.29 | 4 |
| IN | $27.76 | 1 |
| KS | $27.48 | 1 |
| KY | $27.83 | 1 |
| LA | $27.84–$28.81 | 2 |
| MA | $30.05–$32.39 | 2 |
| MD | $29.59–$32.67 | 3 |
| ME | $27.85–$28.78 | 2 |
| MI | $28.43–$29.85 | 2 |
| MN | $28.83 | 1 |
| MO | $27.56–$28.77 | 3 |
| MS | $27.23 | 1 |
| MT | $29.39 | 1 |
| NC | $28.04 | 1 |
| ND | $28.60 | 1 |
| NE | $27.56 | 1 |
| NH | $29.76 | 1 |
| NJ | $31.32–$32.51 | 2 |
| NM | $28.58 | 1 |
| NV | $29.18 | 1 |
| NY | $28.34–$33.96 | 5 |
| OH | $28.27 | 1 |
| OK | $27.70 | 1 |
| OR | $28.94–$30.74 | 2 |
| PA | $28.25–$30.46 | 2 |
| PR | $29.52 | 1 |
| RI | $29.96 | 1 |
| SC | $28.20 | 1 |
| SD | $28.51 | 1 |
| TN | $27.59 | 1 |
| TX | $28.13–$30.03 | 8 |
| UT | $28.47 | 1 |
| VA | $28.78–$32.67 | 2 |
| VI | $29.52 | 1 |
| VT | $28.60 | 1 |
| WA | $29.96–$32.86 | 2 |
| WI | $27.92 | 1 |
| WV | $28.26 | 1 |
| WY | $29.05 | 1 |
How the G0011 rate is calculated
Each of G0011’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · G0011
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.45Practice expense 0.39Malpractice 0.04
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for G0011
G0011 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · G0011
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$29.39
The facility rate would be $21.71 (+$7.68). In a facility, the facility bills its own costs separately.
G0011 compared with similar codes
Compare codes
G0011 vs G0013 vs G0012 vs 99401: national Medicare rates
Swap in your local Medicare rate.
How to choose
- G0013HIV PrEP counseling
- Both codes represent HIV PrEP counseling for 15–30 minutes. Choose G0011 when a physician furnishes the counseling; G0013 is for counseling furnished by clinical staff.
- G0012PrEP injection
- G0012 represents an HIV PrEP drug injection, not counseling. G0011 is appropriate for the physician’s qualifying prevention counseling.
- 99401Prev med cnsl indiv apprx 15
- 99401 is individual preventive counseling of a general nature. G0011 specifically identifies physician counseling about HIV PrEP.
G0011 billing questions
When should G0011 be chosen instead of G0013?
G0011 represents HIV PrEP counseling furnished by a physician for 15–30 minutes. G0013 is the corresponding counseling code when clinical staff furnish the service.
Does G0011 include a PrEP injection?
No. G0011 represents counseling; G0012 represents an HIV PrEP drug injection. Report each only when that service is actually furnished and documented.
What time should the record support?
Document 15–30 minutes spent on the physician’s HIV PrEP counseling. The record should make clear that the time relates to this counseling service.
Can G0011 be reported with G0012 on the same date?
They represent different services. If the physician provides qualifying counseling and an HIV PrEP injection is administered during the encounter, document both services.
How does G0011 differ from 99401?
G0011 specifically represents physician counseling about HIV PrEP. 99401 is a general individual preventive counseling code, rather than the HIV PrEP-specific service.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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