Question 1

What is HCPCS code G0011?

Accepted Answer

HCPCS code G0011 is "Hiv prep counsel, md 15-30m". 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

Question 2

What category is G0011 in?

Accepted Answer

G0011 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0011?

Accepted Answer

Use G0011 when billing for hiv prep counsel, md 15-30m. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G0011 covered by Medicare?

Accepted Answer

Coverage for G0011 (Hiv prep counsel, md 15-30m) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G0011?

Accepted Answer

Documentation for G0011 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).