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See a sample rate comparisonHCPCS G0011 Fee Schedule
Last Verified: September 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 Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Psychotherapy, Pre-Exposure Prophylaxis Counseling and Community Health Integration Services |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for G0011 |
National average reimbursement for HCPCS G0011 by major payers:
$33.01
$31.12
$29.18
$40.67
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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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See a sample payer proposalHCPCS 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.
| 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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