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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.

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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.

Service type: Individual preventive counseling session focused on PrEP education, risk assessment, risk-reduction strategies, and adherence support
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.

Find policies, billing codes, payers, states, and providers

HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

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Get alerted when payer policies referencing G0011 are released or updated.

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Billing Code Overview

Service type: Individual preventive counseling session focused on PrEP education, risk assessment, risk-reduction strategies, and adherence support
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`	Unusual anesthesia	Not typically used for counseling; included when unexpected anesthesia is required during a related procedure (rare).
`52`	Reduced services	Use when the counseling session was significantly shortened or components of the service were not performed.
`53`	Discontinued procedure	Use if the counseling session was started but discontinued due to patient or provider decision.
`59`	Distinct procedural service	Use when this counseling is separate and distinct from other services performed the same day (e.g., separate from a visit with a different primary focus).
`62`	Two surgeons — not applicable to counseling but available	Rarely applicable; would not normally apply to this code.
`78`	Return to OR following procedure	Not applicable to routine counseling; included for completeness.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use when the PrEP counseling visit is delivered via live telehealth.
`GQ`	Telehealth — asynchronous (store and forward)	Use if allowed by payer for non–real-time telehealth counseling communications.
`GT`	Via interactive audio and video (real-time telehealth)	Alternative telehealth modifier for payers requiring `GT` instead of `95`.
`QK`	Medical direction of two or more assistants at surgery	Not applicable to counseling; generally not used.
`QX`	Non-physician practitioner with modifier `QY`/`QX` pairing	Use when a clinical pharmacist or qualified non-physician provides the counseling under appropriate supervision agreements and payer requires this modifier.
`QY`	Ordered/referred by physician for APRN/PA services	Use when the counseling is provided by an APN/PA as part of a referral/ordering arrangement per payer rules.

Taxonomy Code	Specialty	Notes
`208000000X`	Family Medicine	Common primary care providers who initiate and counsel for PrEP.
`207Q00000X`	Internal Medicine	Internists frequently provide PrEP counseling and management.
`363L00000X`	Infectious Disease	Specialists managing complex PrEP candidates or coexisting HIV/STI issues.
`207P00000X`	Physician Assistant	Mid-level providers who commonly provide counseling and initiation of PrEP.
`207V00000X`	Nurse Practitioner	Nurse practitioners who provide counseling, prescribe, and monitor PrEP.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z20.6`	Contact with and (suspected) exposure to HIV	Relevant for patients with potential recent exposure or high ongoing risk prompting PrEP consideration.
`Z72.5`	High-risk sexual behavior	Indicates behaviors that increase HIV acquisition risk and justify PrEP counseling.
`Z11.3`	Encounter for screening for infections with a predominantly sexual mode of transmission	Used when screening for STIs as part of PrEP initiation or follow-up.
`Z71.7`	HIV counseling	Specific counseling code that parallels the counseling elements in `G0011`.
`F11.20`	Opioid dependence, uncomplicated	Substance use disorders can increase HIV risk; included when coexisting conditions influence counseling and adherence planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common E/M code for a focused visit that may occur the same day as PrEP counseling; used when additional evaluation/management is provided.
`99401`	Preventive medicine counseling and/or risk factor reduction intervention, individual, approximately 15 minutes	Overlaps with counseling services; payers may require using the specific HCPCS `G0011` for PrEP counseling instead of this preventive counseling CPT.
`87070`	Culture, bacterial; any other source except urine, blood or stool	Used when STI testing cultures are obtained during the visit or as part of baseline evaluation.
`87270`	Infectious agent antigen detection by immunofluorescent technique	Example of laboratory testing that may accompany the visit for STI screening; ordered as part of the clinical workflow.
`80053`	Comprehensive metabolic panel	Ordered to assess renal function and electrolytes prior to or during PrEP initiation and monitoring.
`87389`	HIV test, antigen/antibody combination immunoassay	Baseline and follow-up HIV testing performed in the clinical workflow supporting PrEP counseling.

HCPCS G9490: Home Visit Assessment for Non-Homebound Patients

HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

HCPCS G0008: Influenza Virus Vaccine Administration

HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

HCPCS G0009: Administration of Pneumococcal Vaccine

HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

HCPCS G0010: Administration of Hepatitis B Vaccine

HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

HCPCS G0012: Injection of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention

HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

HCPCS G0013: Individual PrEP Counseling and HIV Risk Assessment

HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

HCPCS G0019: Community Health Integration for Social Determinants of Health

HCPCS-G0022-COMMUNITY-HEALTH-INTEGRATION-ADDITIONAL-30-MIN

HCPCS G0022: Community Health Integration, Additional 30 Minutes

Showing 1–10 of 1996

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard service	Use when no special circumstances apply and service is billed routinely.
`23`	Unusual anesthesia	Not typically used for counseling; included when unexpected anesthesia is required during a related procedure (rare).
`52`	Reduced services	Use when the counseling session was significantly shortened or components of the service were not performed.
`53`	Discontinued procedure	Use if the counseling session was started but discontinued due to patient or provider decision.
`59`	Distinct procedural service	Use when this counseling is separate and distinct from other services performed the same day (e.g., separate from a visit with a different primary focus).
`62`	Two surgeons — not applicable to counseling but available	Rarely applicable; would not normally apply to this code.
`78`	Return to OR following procedure	Not applicable to routine counseling; included for completeness.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use when the PrEP counseling visit is delivered via live telehealth.
`GQ`	Telehealth — asynchronous (store and forward)	Use if allowed by payer for non–real-time telehealth counseling communications.
`GT`	Via interactive audio and video (real-time telehealth)	Alternative telehealth modifier for payers requiring `GT` instead of `95`.
`QK`	Medical direction of two or more assistants at surgery	Not applicable to counseling; generally not used.
`QX`	Non-physician practitioner with modifier `QY`/`QX` pairing	Use when a clinical pharmacist or qualified non-physician provides the counseling under appropriate supervision agreements and payer requires this modifier.
`QY`	Ordered/referred by physician for APRN/PA services	Use when the counseling is provided by an APN/PA as part of a referral/ordering arrangement per payer rules.

Taxonomy Code	Specialty	Notes
`208000000X`	Family Medicine	Common primary care providers who initiate and counsel for PrEP.
`207Q00000X`	Internal Medicine	Internists frequently provide PrEP counseling and management.
`363L00000X`	Infectious Disease	Specialists managing complex PrEP candidates or coexisting HIV/STI issues.
`207P00000X`	Physician Assistant	Mid-level providers who commonly provide counseling and initiation of PrEP.
`207V00000X`	Nurse Practitioner	Nurse practitioners who provide counseling, prescribe, and monitor PrEP.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z20.6`	Contact with and (suspected) exposure to HIV	Relevant for patients with potential recent exposure or high ongoing risk prompting PrEP consideration.
`Z72.5`	High-risk sexual behavior	Indicates behaviors that increase HIV acquisition risk and justify PrEP counseling.
`Z11.3`	Encounter for screening for infections with a predominantly sexual mode of transmission	Used when screening for STIs as part of PrEP initiation or follow-up.
`Z71.7`	HIV counseling	Specific counseling code that parallels the counseling elements in `G0011`.
`F11.20`	Opioid dependence, uncomplicated	Substance use disorders can increase HIV risk; included when coexisting conditions influence counseling and adherence planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common E/M code for a focused visit that may occur the same day as PrEP counseling; used when additional evaluation/management is provided.
`99401`	Preventive medicine counseling and/or risk factor reduction intervention, individual, approximately 15 minutes	Overlaps with counseling services; payers may require using the specific HCPCS `G0011` for PrEP counseling instead of this preventive counseling CPT.
`87070`	Culture, bacterial; any other source except urine, blood or stool	Used when STI testing cultures are obtained during the visit or as part of baseline evaluation.
`87270`	Infectious agent antigen detection by immunofluorescent technique	Example of laboratory testing that may accompany the visit for STI screening; ordered as part of the clinical workflow.
`80053`	Comprehensive metabolic panel	Ordered to assess renal function and electrolytes prior to or during PrEP initiation and monitoring.
`87389`	HIV test, antigen/antibody combination immunoassay	Baseline and follow-up HIV testing performed in the clinical workflow supporting PrEP counseling.

HCPCS G9490: Home Visit Assessment for Non-Homebound Patients

HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

HCPCS G0008: Influenza Virus Vaccine Administration

HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

HCPCS G0009: Administration of Pneumococcal Vaccine

HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

HCPCS G0010: Administration of Hepatitis B Vaccine

HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

HCPCS G0012: Injection of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention

HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

HCPCS G0013: Individual PrEP Counseling and HIV Risk Assessment

HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

HCPCS G0019: Community Health Integration for Social Determinants of Health

HCPCS-G0022-COMMUNITY-HEALTH-INTEGRATION-ADDITIONAL-30-MIN

HCPCS G0022: Community Health Integration, Additional 30 Minutes

Showing 1–10 of 1996

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

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Billing Code Overview

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HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References