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    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g0012-pre-exposure-prophylaxis-injection-hiv-prevention
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    HCPCS G0012: Injection of PrEP Drug for HIV Prevention

    Medicare pays $16 on average nationally for this procedure.

    HCPCS Level II code G0012 represents administration of a pre-exposure prophylaxis (PrEP) medication by injection given either subcutaneously or intramuscularly for HIV prevention; the service is an injection procedure typically provided in outpatient clinic, ambulatory care, or public health clinic settings and is billed as a single administration of the prophylactic drug under the HCPCS Level II reporting conventions.

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

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    Clinical & Coding Specifications

    Clinical Context

    A sexually active adult patient at increased risk for HIV presents to an outpatient clinic for initiation or continuation of long-acting injectable pre-exposure prophylaxis. The clinical workflow includes eligibility assessment (HIV testing, renal function, hepatitis screening), patient counseling on adherence and safer sex practices, confirmation of negative HIV status on the day of injection, and administration of the intramuscular injection. The injection is administered under the skin or into muscle in a clinic procedure room, urgent care, community health center, or designated injection suite. Observation for a short period post-injection for immediate adverse reactions is typical. Documentation includes the G0012 service, drug name and NDC, lot number, injection site, route, patient consent, and relevant labs and screening results in the medical record.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesUsed for routine counseling, eligibility assessment, and follow-up visits associated with PrEP injection administration
    36415Collection of venous blood by venipuncturePerformed pre-injection for HIV testing, renal function, and hepatitis screening
    81025Urine pregnancy test, by dipstick or tablet reagent for pregnancyPerformed prior to initiating PrEP in persons of childbearing potential
    87804Infectious agent antigen detection by immunoassay, single step method; HIV-1/2 antigen/antibodyPoint-of-care HIV testing on the day of injection to confirm negative status
    96372Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscularOften used when a generic injection code is reported in settings where G0012 is not applicable or to capture administration when billing rules require a CPT code in addition to the HCPCS code

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207Q00000X
    207L00000X
    207P00000X
    367500000X
    207XS0114X
    363LA2100X
    207SG0201X
    2251H1300X

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    B20Human immunodeficiency virus [HIV] disease
    F11.21Opioid dependence, in remission
    F17.200Nicotine dependence, unspecified, uncomplicated
    R75Inconclusive laboratory evidence of human immunodeficiency virus [HIV]
    R76.11Nonspecific reaction to tuberculin skin test without active tuberculosis
    R76.12Nonspecific reaction to cell mediated immunity measurement of gamma interferon antigen response without active tuberculosis
    Z00.00Encounter for general adult medical examination without abnormal findings
    Z00.01Encounter for general adult medical examination with abnormal findings
    Z11.3Encounter for screening for infections with a predominantly sexual mode of transmission
    Z11.4Encounter for screening for human immunodeficiency virus [HIV]

    Showing 1–10 of 24

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    HCPCS-G9490-HOME-ASSESSMENT-NON-HOMEBOUND

    HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

    HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

    HCPCS G0008: Administration of Influenza Virus Vaccine

    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-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

    HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

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

    HCPCS G0013: Individual PrEP Counseling by Clinical Staff

    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, Person-Centered Assessment

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

    HCPCS G0022: Community Health Integration, Additional 30 Minutes

    Showing 1–10 of 1996

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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