HCPCS G0012: PrEP injectionMedicare rate & RVUs
Report G0012 for administering injectable HIV pre-exposure prophylaxis, such as long-acting cabotegravir, under physician supervision.
Medicare pays $15.36 for G0012 nationally in the office. Local office rates run $13.88–$19.97.
Medicare rate · G0012
PrEP injection
Swap in your local Medicare rate.
- Work RVUs
- 0.17
- Total RVUs
- 0.46
- Global days
- XXX
National rate · 2026
$15.36
Office setting, before claim adjustments.
See every locality for G0012 → · 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 G0012 covers
G0012 represents the clinical service of administering an injectable medication for HIV pre-exposure prophylaxis. It is used when a patient receives a prescribed PrEP injection to reduce the risk of acquiring HIV; long-acting cabotegravir is a common example. The injection is generally given by clinical staff in a medical office or clinic as part of the patient’s PrEP care.
Report G0012 for the administration service, not for counseling alone. When the drug product is separately reportable, identify it with its applicable drug code; for cabotegravir, that may include J0739. The record should support that an injectable PrEP medication was administered, with the medication and administration documented. CMS identifies this as an incident-to service: bill it only when performed under physician supervision.
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 G0012 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
$13.88 to $19.97
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $14.05 | Unavailable |
| Alaska* | $18.66 | Unavailable |
| Arizona | $15.03 | Unavailable |
| Arkansas | $13.88 | Unavailable |
| Atlanta | $15.60 | Unavailable |
| Austin | $15.88 | Unavailable |
| Bakersfield | $16.24 | Unavailable |
| Baltimore/Surr. Cntys | $16.22 | Unavailable |
| Beaumont | $14.50 | Unavailable |
| Brazoria | $15.25 | Unavailable |
| Chicago | $15.88 | Unavailable |
| Chico | $16.20 | Unavailable |
| Colorado | $15.96 | Unavailable |
| Connecticut | $16.27 | Unavailable |
| Dallas | $15.33 | Unavailable |
| Dc + Md/Va Suburbs | $17.37 | Unavailable |
| Delaware | $15.25 | Unavailable |
| Detroit | $15.27 | Unavailable |
| East St. Louis | $14.95 | Unavailable |
| El Centro | $16.21 | Unavailable |
| Fort Lauderdale | $15.76 | Unavailable |
| Fort Worth | $15.24 | Unavailable |
| Fresno | $16.20 | Unavailable |
| Galveston | $15.29 | Unavailable |
| Hanford-Corcoran | $16.20 | Unavailable |
| Hawaii, Guam | $16.51 | Unavailable |
| Houston | $15.47 | Unavailable |
| Idaho | $14.44 | Unavailable |
| Indiana | $14.51 | Unavailable |
| Iowa | $14.37 | Unavailable |
| Kansas | $14.30 | Unavailable |
| Kentucky | $14.30 | Unavailable |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $17.20 | Unavailable |
| Madera | $16.20 | Unavailable |
| Manhattan | $17.44 | Unavailable |
| Merced | $16.20 | Unavailable |
| Metropolitan Boston | $17.37 | Unavailable |
| Metropolitan Kansas City | $14.79 | Unavailable |
| Metropolitan Philadelphia | $15.91 | Unavailable |
| Metropolitan St. Louis | $14.92 | Unavailable |
| Miami | $16.26 | Unavailable |
| Minnesota | $15.40 | Unavailable |
| Mississippi | $13.98 | Unavailable |
| Modesto | $16.20 | Unavailable |
| Montana** | $15.36 | Unavailable |
| Napa | $18.53 | Unavailable |
| Nebraska | $14.44 | Unavailable |
| Nevada** | $15.32 | Unavailable |
| New Hampshire | $15.71 | Unavailable |
| New Mexico | $14.66 | Unavailable |
| New Orleans | $14.86 | Unavailable |
| North Carolina | $14.62 | Unavailable |
| North Dakota** | $15.17 | Unavailable |
| Northern Nj | $17.24 | Unavailable |
| Nyc Suburbs/Long Island | $17.78 | Unavailable |
| Ohio | $14.55 | Unavailable |
| Oklahoma | $14.29 | Unavailable |
| Oxnard-Thousand Oaks-Ventura | $17.10 | Unavailable |
| Portland | $16.41 | Unavailable |
| Poughkpsie/N Nyc Suburbs | $16.58 | Unavailable |
| Puerto Rico | $15.46 | Unavailable |
| Queens | $17.58 | Unavailable |
| Redding | $16.20 | Unavailable |
| Rest Of California | $16.20 | Unavailable |
| Rest Of Florida | $15.12 | Unavailable |
| Rest Of Georgia | $14.42 | Unavailable |
| Rest Of Illinois | $14.74 | Unavailable |
| Rest Of Louisiana | $14.27 | Unavailable |
| Rest Of Maine | $14.49 | Unavailable |
| Rest Of Maryland | $15.51 | Unavailable |
| Rest Of Massachusetts | $15.88 | Unavailable |
| Rest Of Michigan | $14.59 | Unavailable |
| Rest Of Missouri | $14.07 | Unavailable |
| Rest Of New Jersey | $16.48 | Unavailable |
| Rest Of New York | $14.80 | Unavailable |
| Rest Of Oregon | $15.23 | Unavailable |
| Rest Of Pennsylvania | $14.58 | Unavailable |
| Rest Of Texas | $14.86 | Unavailable |
| Rest Of Washington | $15.85 | Unavailable |
| Rhode Island | $15.74 | Unavailable |
| Riverside-San Bernardino-Ontario | $16.32 | Unavailable |
| Sacramento-Roseville-Folsom | $16.94 | Unavailable |
| Salinas | $16.87 | Unavailable |
| San Diego-Chula Vista-Carlsbad | $17.21 | Unavailable |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $19.56 | Unavailable |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $19.55 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $19.97 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $19.92 | Unavailable |
| San Luis Obispo-Paso Robles | $16.61 | Unavailable |
| Santa Cruz-Watsonville | $17.34 | Unavailable |
| Santa Maria-Santa Barbara | $16.92 | Unavailable |
| Santa Rosa-Petaluma | $17.51 | Unavailable |
| Seattle (King Cnty) | $17.71 | Unavailable |
| South Carolina | $14.60 | Unavailable |
| South Dakota** | $15.14 | Unavailable |
| Southern Maine | $15.16 | Unavailable |
| Stockton | $16.20 | Unavailable |
| Suburban Chicago | $15.91 | Unavailable |
| Tennessee | $14.36 | Unavailable |
| Utah | $14.77 | Unavailable |
| Vallejo | $18.52 | Unavailable |
| Vermont | $15.11 | Unavailable |
| Virgin Islands | $15.46 | Unavailable |
| Virginia | $15.11 | Unavailable |
| Visalia | $16.20 | Unavailable |
| West Virginia | $14.28 | Unavailable |
| Wisconsin | $14.74 | Unavailable |
| Wyoming** | $15.28 | Unavailable |
| Yuba City | $16.20 | Unavailable |
G0012 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.
$13.88
$18.66
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 | $18.66 | 1 |
| AL | $14.05 | 1 |
| AR | $13.88 | 1 |
| AZ | $15.03 | 1 |
| CA | $16.20–$19.97 | 29 |
| CO | $15.96 | 1 |
| CT | $16.27 | 1 |
| DC | $17.37 | 1 |
| DE | $15.25 | 1 |
| FL | $15.12–$16.26 | 3 |
| GA | $14.42–$15.60 | 2 |
| GU | $16.51 | 1 |
| HI | $16.51 | 1 |
| IA | $14.37 | 1 |
| ID | $14.44 | 1 |
| IL | $14.74–$15.91 | 4 |
| IN | $14.51 | 1 |
| KS | $14.30 | 1 |
| KY | $14.30 | 1 |
| LA | $14.27–$14.86 | 2 |
| MA | $15.88–$17.37 | 2 |
| MD | $15.51–$17.37 | 3 |
| ME | $14.49–$15.16 | 2 |
| MI | $14.59–$15.27 | 2 |
| MN | $15.40 | 1 |
| MO | $14.07–$14.92 | 3 |
| MS | $13.98 | 1 |
| MT | $15.36 | 1 |
| NC | $14.62 | 1 |
| ND | $15.17 | 1 |
| NE | $14.44 | 1 |
| NH | $15.71 | 1 |
| NJ | $16.48–$17.24 | 2 |
| NM | $14.66 | 1 |
| NV | $15.32 | 1 |
| NY | $14.80–$17.78 | 5 |
| OH | $14.55 | 1 |
| OK | $14.29 | 1 |
| OR | $15.23–$16.41 | 2 |
| PA | $14.58–$15.91 | 2 |
| PR | $15.46 | 1 |
| RI | $15.74 | 1 |
| SC | $14.60 | 1 |
| SD | $15.14 | 1 |
| TN | $14.36 | 1 |
| TX | $14.50–$15.88 | 8 |
| UT | $14.77 | 1 |
| VA | $15.11–$17.37 | 2 |
| VI | $15.46 | 1 |
| VT | $15.11 | 1 |
| WA | $15.85–$17.71 | 2 |
| WI | $14.74 | 1 |
| WV | $14.28 | 1 |
| WY | $15.28 | 1 |
How the G0012 rate is calculated
Each of G0012’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 · G0012
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.17Practice expense 0.28Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for G0012
The CMS indicators that decide how G0012 is paid alongside other services.
CMS payment indicators · G0012
PrEP injection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 5 | Incident-to service. |
G0012 compared with similar codes
Compare codes
G0012 vs G0011 vs G0013 vs J0739: national Medicare rates
Swap in your local Medicare rate.
How to choose
- G0011PrEP counseling
- Use G0011 for qualifying HIV PrEP counseling by a physician or other qualified health care professional; use G0012 for administering the injectable PrEP medication.
- G0013HIV PrEP counseling
- G0013 describes qualifying HIV PrEP counseling by clinical staff, not the injection service represented by G0012.
- J0739Hiv prep, inj, cabotegravir
- J0739 identifies cabotegravir by drug quantity; G0012 represents the administration service.
G0012 billing questions
How is G0012 different from G0011?
G0012 represents administration of an injectable HIV PrEP medication. G0011 is for qualifying HIV PrEP counseling by a physician or other qualified health care professional.
How is G0012 different from G0013?
G0012 covers the injection service. G0013 is for qualifying HIV PrEP counseling furnished by clinical staff.
Can the drug product be reported separately?
Report the drug product separately when applicable and separately reportable. For cabotegravir, J0739 may identify the drug; G0012 represents its administration.
What supervision is required for billing G0012?
CMS identifies G0012 as an incident-to service, so it may be billed only when performed under physician supervision.
What should the record document?
Document that an injectable medication for HIV PrEP was administered and identify the medication given. The service must also meet the physician-supervision condition for incident-to billing.
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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