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HCPCS G0011 Fee Schedule

Last Verified: July 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

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 FactDetail
Service Type

Procedures / Professional Services

Psychotherapy, Pre-Exposure Prophylaxis Counseling and Community Health Integration Services

Complexity LevelLow

National average reimbursement for HCPCS G0011 by major payers:

bcbs

$33.01

uhc

$31.12

aetna

$29.18

cigna

$40.67

Preview provider-level rates for...
For billing codeHCPCS G0011
PayerCodeRateNPITax IDStateSpecialty
United
G0011$36.881790942381 - TATTNALL HOSPITAL COMPANY, LLC, OPTIM MEDICAL CENTER - TATTNALL300466706GACritical Access Hospital (282NC0060X)
United
G0011$57.541225281603 - EMORY CRAWFORD LONG HOSPITAL581537752 - EMORY UNIVERSITYGAGeneral Acute Care Hospital (282N00000X)
United
G0011$28.511003894056 - MICHAEL CASEY812808787NCNephrology Physician (207RN0300X)
United
G0011$31.601417157405 - EMORY HEALTHCARE711018941 - CARDIAC ARRHYTHMIA INSTITUTEGAGeneral Acute Care Hospital (282N00000X)
United
G0011$65.731003166612 - MATTHEW LILLEY931261079 - THE ORTHOPEDIC AND NEUROSURGICAL CENTER OF THE CASCADESOROrthopaedic Surgery Physician (207X00000X)
United
G0011$49.311801813266 - GREGG BEAN741671142 - (TX) SOUTH TEXAS RADIOLOGY GROUP, P.A.TXDiagnostic Radiology Physician (2085R0202X)
United
G0011$31.471962462226 - TIFT REGIONAL HEALTH SYSTEM INC., TIFT REGIONAL MEDICAL CENTER453072990 - (GA) TIFT REGIONAL HEALTH SYSTEM INCGAGeneral Acute Care Hospital (282N00000X)
United
G0011$31.321801883780 - TANNER MEDICAL CENTER, INC, TANNER HEALTH SYSTEM581790149 - (GA) TANNER MEDICAL CENTER INCGAGeneral Acute Care Hospital (282N00000X)
United
G0011$34.081184771586 - LOWER OCONEE COMMUNITY HOSPITAL INC208897263GACritical Access Hospital (282NC0060X)
United
G0011$70.011710992433 - HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLE, JEFFERSON HOSPITAL581309961 - (GA) HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLEGAGeneral Acute Care Hospital (282N00000X)
United
G0011$61.611841651056 - KAMRAN RAJAEE273818647GAGeneral Acute Care Hospital (282N00000X)
United
G0011$56.861063741163 - AZTEC URGENT CARE, LLC271495988 - (NM) AZTEC URGENT CARE LLCNMUrgent Care Clinic/Center (261QU0200X)
United
G0011$48.651083711691 - TY COBB HEALTHCARE SYSTEM, COBB MEMORIAL HOSPITAL580633978 - (GA) COMMUNITY SERVICES GROUP INCGARural Acute Care Hospital (282NR1301X)
United
G0011$37.341861478851 - CLINCH COUNTY HOSPITAL AUTHORITY586011853 - (GA) CLINCH COUNTY HOSPITAL AUTHORITYGACritical Access Hospital (282NC0060X)
United
G0011$44.521033320049 - ANN STECK10877201OHFamily Medicine Physician (207Q00000X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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HCPCS G0011 vs. Other Psychotherapy, Pre-Exposure Prophylaxis Counseling and Community Health Integration Services Codes

The HCPCS G0011 code is part of the Procedures / Professional Services services used for Psychotherapy, Pre-Exposure Prophylaxis Counseling and Community Health Integration Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The HCPCS G0011 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

CodeComplexityDescription
G0011-HCPCSLowIndividual 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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