$28.43–$29.85
Choose G0013 when clinical staff provide the 15–30-minute PrEP counseling service. G0011 is for the corresponding service provided by a physician or other qualified health care professional.
On this page
CMS RVU26D · Effective 2026-10-01
G0013 HIV PrEP counseling Medicare reimbursement rates in Michigan
Reports 15–30 minutes of HIV pre-exposure prophylaxis counseling delivered by clinical staff to a patient considering or using PrEP. Compare G0013 office and facility rates across CMS payment localities in Michigan.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for G0013 in Michigan?
Michigan has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$22.86–$23.98
2 of 2 localities have a supported rate.
Facility setting
$7.61–$7.86
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Preventive counseling
About G0013: HIV PrEP counseling by clinical staff
Reports 15–30 minutes of HIV pre-exposure prophylaxis counseling delivered by clinical staff to a patient considering or using PrEP.
G0013 represents 15–30 minutes of counseling about HIV pre-exposure prophylaxis (PrEP) provided by clinical staff. The discussion may take place in primary care, infectious disease, or sexual health settings when a patient is considering or using PrEP. Counseling can address HIV prevention and the role of PrEP in the patient’s care; it is distinct from administering an injectable PrEP drug.
Select this code for the clinical-staff counseling service, rather than the corresponding physician or other qualified health care professional service. Documentation should identify the PrEP counseling performed, who provided it, and the time supporting the 15–30-minute service. CMS assigns work, practice-expense, and malpractice relative value units to the service; the applicable fee-schedule data determine payment. The supplied CMS rules identify no additional payment rule for this code.
Where the value comes from
- Work RVU0.18 · 25%
- Practice expense (office) RVU0.54 · 74%
- Malpractice RVU0.01 · 1%
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.
G0013 compared with similar codes
Office rates for Michigan, from the same CMS release.
$14.59–$15.27
G0012 represents injection of an HIV PrEP drug, not counseling. G0013 represents the counseling service.
99401
No office ratePrev med cnsl indiv apprx 15
99401 is a broader individual preventive counseling code. G0013 specifically identifies 15–30 minutes of HIV PrEP counseling by clinical staff.
Compare G0013 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Detroit →
Office / nonfacility
$23.98
Facility
$7.86
Rest Of Michigan →
Office / nonfacility
$22.86
Facility
$7.61
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G0013 billing questions
How does G0013 differ from G0011?
G0013 is for 15–30 minutes of HIV PrEP counseling by clinical staff. G0011 is the corresponding counseling service when provided by a physician or other qualified health care professional.
Does G0013 describe a PrEP injection?
No. G0013 describes counseling; G0012 describes injection of an HIV PrEP drug.
What time should the record support?
Document 15–30 minutes of PrEP counseling and identify the staff member who provided it.
What documentation supports reporting G0013?
Record the PrEP-related counseling provided, the clinical staff member, and the time spent. The documentation should make clear that the service was counseling rather than drug administration.
Can counseling and an injectable PrEP service occur on the same date?
Yes, a patient may receive counseling and an injection during the same encounter. G0013 represents the counseling; G0012 represents the injection 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
15,016G0010,,Admin hepatitis b vaccine,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,017G0011,,"Hiv prep counsel, md 15-30m",A,,0.45,0.39,,0.16,,0.04,0.88,0.65,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,018G0012,,Injection of hiv prep drug,A,,0.17,0.28,,0.28,NA,0.01,0.46,0.46,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,019G0013,,"Hiv prep counsel, clin staff",A,,0.18,0.54,,0.04,,0.01,0.73,0.23,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,020G0017,,Crisis psychotherapy 60m,A,,4.70,1.79,,0.40,,0.05,6.54,5.15,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,021G0018,,Crisis psychotherapy add 30m,A,,2.25,0.87,,0.21,,0.03,3.15,2.49,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,022G0019,,Comm hlth intg svs sdoh 60mn,A,,1.00,1.51,,0.25,,0.07,2.58,1.32,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00