Is G0011 covered by Medicare?

Coverage varies by code, payer, and clinical context. Cross-check the current Medicare Local Coverage Determination (LCD) for the adjudicating Medicare Administrative Contractor (MAC), and any commercial payer policy for non-Medicare patients. Many HCPCS Level II codes (especially DME and certain drugs) require prior authorization.

What documentation is required for G0011?

Documentation must support medical necessity per the payer LCD or commercial-payer policy. For DME codes: written order, face-to-face encounter where required, beneficiary education. For drug codes: NDC, dose administered, units, route, site, wastage if applicable. For ambulance: origin, destination, miles, medical necessity. For supplies: linked diagnosis and medical necessity.

What are common denial reasons for G0011?

The most common denial categories are CO-16 (information missing or incorrect), CO-50 (medical necessity), and CO-151 (benefit maximum reached, often for DME rental cycles). Specific denial behavior varies by payer and plan.

Who can I get help from on G0011 billing?

For specialty-specific coding questions, AAPC- and AHIMA-credentialed coders on the Medonix team handle production billing for U.S. healthcare practices including HCPCS Level II claims (drugs, DME, ambulance, Medicare-specific procedures). Book a discovery call at /audit/ to talk through your specialty and payer mix.

HCPCS Level II · Procedures and professional services (temporary)

G0011: Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp) to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes

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G0011 is the HCPCS Level II code for Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp) to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes. Section G, Procedures and professional services (temporary). Section-level billing guidance applies.

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G0011Hiv prep counsel, md 15-30m

Section: GCategory: Procedures and professional services (temporary)Billable

About this code

Hiv prep counsel, md 15-30m.

G0011 is a HCPCS Level II code in section G (Procedures and professional services (temporary)). The full official descriptor is: Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp) to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes.

G-codes are temporary procedure or professional service codes used by Medicare and other payers for items where CPT does not yet have a code. Document per the specific G-code descriptor (Annual Wellness Visit history, depression screening, etc.).

Payer-specific coverage rules vary. Always cross-check against the current Medicare Local Coverage Determination (LCD) for the adjudicating Medicare Administrative Contractor (MAC) or the commercial-payer policy.

Billing context

What practitioners watch for on G0011.

Section-level billing guidance for procedures and professional services (temporary). Code-specific notes ship as the dataset matures.

Documentation

Common denial categories

CO-16: Information missing or incorrect on the claim or supporting documentation. Add documentation specificity (NDC for drugs, serial number for DME, mileage for transport) and resubmit.
CO-50: Service not deemed medically necessary. Confirm the diagnosis-procedure relationship matches the payer LCD/NCD; attach clinical justification and resubmit.
CO-151: Payer benefit maximum reached for this period (often DME rental cycles). Verify benefit history; for DME rental-to-purchase cycles confirm month count and switch billing to purchase code where applicable.

Coverage signal

Many G-codes are Medicare-specific. Commercial payers may or may not accept them. Annual Wellness Visit codes (G0438, G0439) are Medicare-only and cannot be billed for non-Medicare patients.

Common specialties

Family Medicine · Internal Medicine

Companion codes

Codes commonly billed alongside G0011 based on Medonix client production data and CMS coding guidance.

2 codes

G0438Initial Annual Wellness Visit (Medicare)HCPCS
G0439Subsequent Annual Wellness Visit (Medicare)HCPCS

CPT is a registered trademark of the American Medical Association. Codes shown for educational reference only.

Related codes

Other codes in section G.

Search all codes

Sources

Where this entry comes from.

NLM Clinical Tables Search Service: the official U.S. National Library of Medicine API for HCPCS Level II lookup.
CMS HCPCS Quarterly Update: the authoritative HCPCS Level II release with annual major updates each January.
CMS Medicare Coverage Database: Local Coverage Determinations and National Coverage Determinations for payer-specific rules.

Frequently asked

About HCPCS code G0011.

G0011 is the HCPCS Level II code for Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp) to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes. It belongs to section G (Procedures and professional services (temporary)). Document the supply, drug, or service per the code descriptor and pair with the diagnosis (ICD-10) supporting medical necessity.

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