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See a sample rate comparisonHCPCS G0012 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.
Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle
| 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 G0012 |
National average reimbursement for HCPCS G0012 by major payers:
$20.71
$23.97
$15.21
$23.51
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HCPCS G0012
5 of 25 sample ratesHigher to lower in this preview
Matthew Lilley
Bend Memorial Clinic, PC
$43.69Published rateGrady Memorial Hospital Corporation, Grady Health Systems
Emory University
$31.42Published rateAnn Steck
$25.36Published rateAndrew Laster
Arthritis And Osteoporosis Consultants Of The Carolinas, PA
$19.23Published rateHospital Authority Of Washington County, Washington County Regional Medical Center
Hospital Authority Of Washington County
$15.44Published rate
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See a sample payer proposalHCPCS G0012 vs. Other Psychotherapy, Pre-Exposure Prophylaxis Counseling and Community Health Integration Services Codes
The HCPCS G0012 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 G0012 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 |
|---|---|---|
| G0012-HCPCS | Low | Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0012. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0012 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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