Summary & Overview
HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment
HCPCS Level II code G0011 represents a brief, targeted counseling service for pre-exposure prophylaxis (PrEP) aimed at preventing HIV through individualized risk assessment, risk-reduction counseling, and medication adherence support. As PrEP is a key preventive intervention for populations at elevated HIV risk, billing and coverage of this counseling service matter nationally for access to prevention, integration into primary care and sexual health services, and consistency of preventive care delivery.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical intent, typical service settings, and what the code captures clinically. The publication outlines payer coverage considerations, common modifiers in billing practice, and where this code fits within preventive service workflows. It also summarizes clinical context—how short, focused counseling sessions support PrEP uptake and adherence—and highlights policy and reimbursement elements that affect implementation across payers. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G0011 describes individual counseling for pre-exposure prophylaxis (PrEP) by a physician or qualified health care professional, intended to prevent human immunodeficiency virus (HIV). The service includes HIV risk assessment (initial or continued assessment of risk), HIV risk reduction counseling, and medication adherence counseling and is delivered in a focused session lasting 15–30 minutes.
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Service type: Individual preventive counseling session focused on PrEP education, risk assessment, risk-reduction strategies, and adherence support
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Typical site of service: Ambulatory outpatient settings such as primary care clinics, sexual health clinics, community health centers, and specialty infectious disease or HIV prevention clinics
Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A 28-year-old cisgender man with multiple sexual partners presents to a primary care clinic seeking pre-exposure prophylaxis. The visit is scheduled as an individual counseling session during which a qualified health care professional performs an HIV risk assessment, discusses HIV risk-reduction strategies, reviews PrEP medication adherence and potential side effects, and arranges baseline laboratory testing (HIV antigen/antibody, renal function, hepatitis B screening). The encounter lasts approximately 20 minutes. Documentation includes patient history of recent condomless receptive anal intercourse, current STI screening results, counseling content, medication plan (emtricitabine/tenofovir formulation), and follow-up plan. Typical workflow: intake and brief vitals by a medical assistant, focused history and risk assessment by a nurse or clinician, counseling and medication discussion by the prescribing clinician or advanced practice provider, ordering of baseline labs, and scheduling of follow-up visits for medication monitoring and adherence support.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard service | Use when no special circumstances apply and service is billed routinely. |
23 |