Question 1

What is HCPCS code G0012?

Accepted Answer

HCPCS code G0012 is "Injection of hiv prep drug". Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle

Question 2

What category is G0012 in?

Accepted Answer

G0012 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0012?

Accepted Answer

Use G0012 when billing for injection of hiv prep drug. 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 G0012 covered by Medicare?

Accepted Answer

Coverage for G0012 (Injection of hiv prep drug) 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 G0012?

Accepted Answer

Documentation for G0012 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).