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See a sample rate comparisonHCPCS G0011 Fee Schedule
Medicare rates as of October 2026
HCPCS G0011 is classified under Procedures / Professional Services, in the Psychotherapy, Pre-Exposure Prophylaxis Counseling and Community Health Integration Services subgroup.
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
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Psychotherapy, Pre-Exposure Prophylaxis Counseling and Community Health Integration Services |
| Complexity Level | Low |
| Medicare Fee Schedule | $29.39 national non-facility rate (2026) · View Medicare rates for G0011 |
| Medicaid Fee Schedule | $23.705 median of the 8 states in the free preview · View Medicaid rates for G0011 |
National average reimbursement for HCPCS G0011 by major payers:
$33.01
BCBS / Anthem
$31.12
UnitedHealthcare
$29.18
Aetna
$40.67
Cigna
Compare published rates across providers.
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HCPCS G0011
5 of 25 sample ratesHigher to lower in this preview
Hospital Authority Of Jefferson County And The City Of Louisville, Jefferson Hospital
Hospital Authority Of Jefferson County And The City Of Louisville
$70.01Published rateAztec Urgent Care, LLC
Aztec Urgent Care LLC
$56.86Published rateMichael Guillette
Aztec Urgent Care LLC
$41.54Published ratePalmyra Park Hospital, Inc., Palmyra Medical Centers
$34.08Published rateMichael Casey
$28.51Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS G0011 vs. Other Psychotherapy, Pre-Exposure Prophylaxis Counseling and Community Health Integration Services Codes
| Code | Complexity | Description |
|---|---|---|
| G0011-HCPCS | Low | 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0011. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0011 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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