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See a sample rate comparisonHCPCS G0012 Fee Schedule
Medicare rates as of October 2026
HCPCS G0012 is classified under Procedures / Professional Services, in the Psychotherapy, Pre-Exposure Prophylaxis Counseling and Community Health Integration Services subgroup.
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 |
| Medicare Fee Schedule | $15.36 national non-facility rate (2026) · View Medicare rates for G0012 |
| Medicaid Fee Schedule | $12.17 median of the 8 states in the free preview · View Medicaid rates for G0012 |
National average reimbursement for HCPCS G0012 by major payers:
$20.71
BCBS / Anthem
$23.97
UnitedHealthcare
$15.21
Aetna
$23.51
Cigna
Compare published rates across providers.
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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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Payer Contract Negotiation
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See a sample payer proposalHCPCS G0012 vs. Other Psychotherapy, Pre-Exposure Prophylaxis Counseling and Community Health Integration Services Codes
| 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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