What Is G2211?
Effective January 1, 2024: In order to address most patient healthcare needs that are consistent and sustained over a period of time, HCPCS has added Code G2211 in the common procedure coding system which reflects the duration, intensity and practice costs associated with office visits provided by physicians who build long term relationships with patients1. The inherent complexity of the visit, which is derived from the longitudinal nature of the practitioner and patient relationship, is captured in G2211.
Code Descriptor
G2211: Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed healthcare services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition, or a complex condition (add-on code, list separately in addition to office or outpatient evaluation and management visit, new or established)1.
Who Can Bill G2211?
Regardless of specialty, all healthcare professionals who can bill office and outpatient evaluation and management visits (CPT codes 99202-99205, 99212-99215), may use G2211 with any E/M visit level. This includes:2
- Physicians
- Hospitals
- Suppliers
- Any other provider billing Medicare Administrative Contractors (MACs) for services they provide to Medicare patients
Who Cannot Bill G2211?
- FQHCs and rural health clinics (RHCs) are paid an encounter rate (rather than based on the complexity of the patient). Therefore, G2211 will be bundled into the FQHC prospective payment system rate and RHC all-inclusive rate.
- Healthcare professionals who do not intend to have an ongoing long-term relationship with the patient.
Billing G2211
Bill G2211 if:
- You’re the ongoing point of convergence for all needed services such as a primary care practitioner, and billing office visit E/M codes (99202-99205, 99211-99215).
- You’re providing ongoing care for a single, serious condition or a complex condition, such as sickle cell disease or HIV.
- The bulleted criteria above have been met, and you’re billing office visit E/M services provided via telehealth.
Do not bill G2211 if:
- Modifier 25 was appended to the associated office visit E/M (codes 99202-99205, 99211-99215).2
- If your relationship with the patient is routine, temporary, time-limited, or discrete. For example, a physician seeing a patient for an acute condition with no intention of assuming responsibility for subsequent care should not report G2211.
The complexity G2211 captures is in the intellectual load of the constant responsibility of being the center point for all needed services for a patient. It is not simply due to the clinical condition they’re treated for. There’s important cognitive effort of using the longitudinal doctor-patient relationship itself in the diagnosis and treatment plan.
Documentation Requirements
The documentation must reflect the reason for billing the office/outpatient evaluation and management visit. In addition, the visits themselves must be medically reasonable and necessary for the practitioner to report G2211, and the documentation should reflect that in detail3.
The following could aid in supporting documentation for billing code G2211:
- Information included in the medical record or in the claim’s history for a patient/practitioner combination, such as diagnoses.
- The practitioner’s assessment and plan for the visit.
- Other service codes billed.
Payment
Medicare will pay for G2211 using the Physician Fee Schedule. The patient’s coinsurance and deductible apply.
For more information on healthcare coding, please reach out to a professional at FORVIS.
- 1“G2211 Add-on Code: What It Is and When To Use It.” aafp.org. February 1, 2024.
- 2“Edits to Prevent Payment of G2211 with Office/Outpatient Evaluation and Management Visit and Modifier 25.” cms.gov. February 1, 2024
- 3“How to Use the Office & Outpatient Evaluation and Management Visit Complexity Add-on Code G2211.” cms.gov. February 1, 2024.