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HCPCS G0013 · Level II · G code

G0013: Individual counseling for pre-exposure prophylaxis (prep) by clinical staff to prevent HIV, 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 G0013

Medicare payment
$24.38
PFS non-facility, national; facility $7.68
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
MUE
none published
no MUE in the 2026 Q4 tables
OPPS status
SI S
Procedure or service, not discounted when multiple
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0
on the Medicare telehealth list

TL;DR

HCPCS Level II G0013 reads "Individual counseling for pre-exposure prophylaxis (prep) by clinical staff to prevent human immunodeficiency virus (hiv), includes: hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence" in the October 2026 file; it dates from 2024. Under the 2026 physician fee schedule (October release) G0013 carries 0.18 work, 0.54 practice-expense and 0.01 malpractice RVUs, which at $33.4009 per RVU pays $24.38 non-facility and $7.68 facility before the locality adjustment. Qualifying APM participants get $24.50 at $33.5675. G0013 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). 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: G0011, G0010, G0009, G0017.

G0013 descriptor and code status

The October 2026 HCPCS Level II file describes G0013 as “Individual counseling for pre-exposure prophylaxis (prep) by clinical staff to prevent human immunodeficiency virus (hiv), includes: hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes.

HCPCS file attributes of G0013
FieldValue
Short descriptorHiv prep counsel, clin staff
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 G0013

Under the 2026 physician fee schedule (October release) G0013 carries 0.18 work, 0.54 practice-expense and 0.01 malpractice RVUs, which at $33.4009 per RVU pays $24.38 non-facility and $7.68 facility before the locality adjustment. Qualifying APM participants get $24.50 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 G0013
ComponentNon-facilityFacility
Work RVU0.180.18
Practice expense RVU0.540.04
Malpractice RVU0.010.01
Total RVUs0.730.23
National payment (CF $33.4009)$24.38$7.68
Qualifying APM participant (CF $33.5675)$24.50$7.72
  • 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 S (Procedure or service, not discounted when multiple), APC 5821 (Level 1 Health and Behavior Services), national unadjusted payment $38.28 with a minimum unadjusted copayment of $0.00.

Medically Unlikely Edits for G0013

CMS publishes no MUE for G0013 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 G0013 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists G0013 in v323r0.

G0013 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 G0013 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0013

No current LCD or billing and coding article lists G0013. 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

G0013 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 G0013

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 G0013 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0013 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 G0013

What does HCPCS code G0013 describe?

"Individual counseling for pre-exposure prophylaxis (prep) by clinical staff to prevent human immunodeficiency virus (hiv), includes: hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence" (short descriptor "Hiv prep counsel, clin staff"), in the G section (procedures and professional services, temporary). Added 2024-01-02.

Is G0013 a CPT code?

No. G0013 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set.

What does Medicare pay for G0013?

Under the 2026 physician fee schedule (October release) G0013 carries 0.18 work, 0.54 practice-expense and 0.01 malpractice RVUs, which at $33.4009 per RVU pays $24.38 non-facility and $7.68 facility before the locality adjustment. Qualifying APM participants get $24.50 at $33.5675.

Does Medicare cover G0013?

G0013 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 G0013 be billed as telehealth?

Yes. G0013 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.