G0011 Insurance Policy Changes

HCPCS G0011 is officially defined as "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." HCPCS G0011 is referenced in 3 tracked payer policy changes from Health Net. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS G0011 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.