$22.74–$25.40
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.
On this page
CMS RVU26D · Effective 2026-10-01
G0011 PrEP counseling Medicare reimbursement rates in Texas
Report G0011 when a physician spends 15–30 minutes counseling a patient about HIV preexposure prophylaxis and reducing HIV acquisition risk. Compare G0011 office and facility rates across CMS payment localities in Texas.
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 G0011 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
$28.13–$30.03
8 of 8 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.
Where G0011 pays more and less in Texas
8 payment localities
$28.13 to $30.03
Preventive counseling
About G0011: Physician HIV PrEP counseling
Report G0011 when a physician spends 15–30 minutes counseling a patient about HIV preexposure prophylaxis and reducing HIV acquisition risk.
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.
Where the value comes from
- Work RVU0.45 · 51%
- Practice expense (office) RVU0.39 · 44%
- Malpractice RVU0.04 · 5%
26
Medicare services in 2024 · #5774 by national volume
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.
G0011 compared with similar codes
Office rates for Texas, from the same CMS release.
$14.50–$15.88
G0012 represents an HIV PrEP drug injection, not counseling. G0011 is appropriate for the physician’s qualifying prevention counseling.
99401
No office ratePrev med cnsl indiv apprx 15
99401 is individual preventive counseling of a general nature. G0011 specifically identifies physician counseling about HIV PrEP.
Compare G0011 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.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office $30.03 | Facility $21.90 |
| Beaumont | Office $28.13 | Facility $21.13 |
| Brazoria | Office $29.10 | Facility $21.49 |
| Dallas | Office $29.29 | Facility $21.63 |
| Fort Worth | Office $29.17 | Facility $21.60 |
| Galveston | Office $29.19 | Facility $21.56 |
| Houston | Office $29.92 | Facility $22.30 |
| Rest Of Texas | Office $28.60 | Facility $21.31 |
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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 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.
15,014G0008,,Admin influenza virus vac,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
15,015G0009,,Admin pneumococcal 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
15,016G0010,,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