G0012 Injection of hiv prep drug

Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle

Medicare pricing for G0012

Physician Fee Schedule (CY 2026, RVU26D)

Status A: active, paid separately under the PFS if covered. National amounts: non-facility $15.36, facility $15.36 (total RVUs 0.46 / 0.46 × $33.4009 conversion factor; facility NA: rarely or never done in that setting). Work RVU 0.17, practice expense RVU 0.28 non-facility and 0.28 facility, malpractice RVU 0.01. Global period XXX. Qualifying APM participants are paid at a $33.5675 conversion factor.

Payer policies and prior authorization for G0012

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • CO: $11.94 (health_first_colorado), effective Jul 1, 2026
  • MS: $54.68 (comprehensive), effective Jul 1, 2026
  • ND: $16.90 (physician), effective Aug 1, 2026
  • OH: $10.69 (physician), effective Jan 1, 2024
  • OK: $12.14 (physician, non-facility), effective Jul 1, 2026
  • TX: $11.32 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), non-facility), effective Sep 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $9.36 (physician, facility), effective Jul 1, 2026
  • WY: $31.84 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.