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HCPCS G0011 · Level II · G code

G0011: HIV prep counsel, md 15-30m, HCPCS Level II G code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for G0011

Medicare payment
$29.39
PFS non-facility, national; facility $21.71
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
MUE
none published
no MUE in the 2026 Q4 tables
OPPS status
SI M
Service not billable to the FI/MAC
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0
on the Medicare telehealth list

TL;DR

CMS describes HCPCS G0011, added in 2024, as "Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp) to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes". Medicare's October 2026 physician fee schedule pays G0011 $29.39 non-facility and $21.71 facility nationally, from 0.45 work, 0.39 practice-expense and 0.04 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $29.54 at $33.5675. G0011 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD. It is on the CY2026 Medicare telehealth list (CMS action: Maintain). OPPS status indicator M: Service not billable to the FI/MAC. HCPCS record: BETOS P5E (ambulatory procedures - other); pricing indicator 13; type of service 1 (medical care). 1 other active code opens with "Individual counseling for pre-exposure prophylaxis"; related codes: G0013, G0010, G0009, G0008.

G0011 descriptor and code status

The October 2026 HCPCS Level II file describes G0011 as “Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp) to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes.

HCPCS file attributes of G0011
FieldValue
Short descriptorHiv prep counsel, md 15-30m
Added to HCPCS2024-01-02
Last actionN (no maintenance), effective 2024-01-02
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator13: physician fee schedule, priced by the contractor
BETOS categoryP5E: ambulatory procedures - other
Type of service1: medical care

Medicare payment for G0011

Medicare's October 2026 physician fee schedule pays G0011 $29.39 non-facility and $21.71 facility nationally, from 0.45 work, 0.39 practice-expense and 0.04 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $29.54 at $33.5675. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status A: active: paid separately under the physician fee schedule when covered. Global period XXX (global surgery concept does not apply); PC/TC indicator 0 (physician service; the professional/technical split does not apply).

PFS relative values and national payment for G0011
ComponentNon-facilityFacility
Work RVU0.450.45
Practice expense RVU0.390.16
Malpractice RVU0.040.04
Total RVUs0.880.65
National payment (CF $33.4009)$29.39$21.71
Qualifying APM participant (CF $33.5675)$29.54$21.82
  • Multiple procedures (modifier 51): no multiple-procedure reduction
  • Bilateral (modifier 50): 150% bilateral adjustment does not apply
  • Assistant at surgery: assistant at surgery paid only with documentation; co-surgeons: co-surgeons not permitted; team surgery: team surgeons not permitted
  • Physician supervision of diagnostic procedures: supervision concept does not apply

Hospital outpatient (OPPS Addendum B)

Status indicator M (Service not billable to the FI/MAC), with no separate OPPS payment rate.

Medically Unlikely Edits for G0011

CMS publishes no MUE for G0011 in the 2026 Q4 practitioner, facility or DME supplier tables. Some MUE values are confidential and applied without publication, so unit limits can still deny; document the quantity furnished on every claim.

The MUE lookup for G0011 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists G0011 in v323r0.

G0011 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check G0011 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0011

No current LCD or billing and coding article lists G0011. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Telehealth status

G0011 is on the CY2026 Medicare telehealth services list (CMS action: Maintain). Bill it with the place-of-service code and modifiers that match where the patient and the practitioner are on the date of service.

Denials to expect on G0011

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units exceed what the payer considers medically likely for one date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for G0011 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0011 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS G0011

What does HCPCS code G0011 describe?

"Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp) to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes" (short descriptor "Hiv prep counsel, md 15-30m"), in the G section (procedures and professional services, temporary). Added 2024-01-02.

Is G0011 a CPT code?

No: CMS maintains G0011 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.

What does Medicare pay for G0011?

Medicare's October 2026 physician fee schedule pays G0011 $29.39 non-facility and $21.71 facility nationally, from 0.45 work, 0.39 practice-expense and 0.04 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $29.54 at $33.5675.

Does Medicare cover G0011?

G0011 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD.

Can G0011 be billed as telehealth?

Yes. G0011 is on the CY2026 Medicare telehealth list (Maintain); the place-of-service and modifier rules on the date of service still apply.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.