On January 1, 2024, the Centers for Medicare and Medicaid Services (CMS) activated  HCPCS add-on code G2211 for Medicare patient billing. The CPT code provides additional reimbursement opportunities for ongoing complex and continuous care provided in an office or outpatient setting.

Procedure Code G2211 is defined by CMS as being used for “visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care 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/outpatient evaluation and management visit, new or established).”

Broken down into more digestible language, it’s used for:

• Instances when a provider coordinates all care for patients with multiple chronic conditions and/or other complex health needs that require ongoing management beyond just managing the clinical condition.
• Instances when a provider that manages care for a patient with one complex condition that requires ongoing care. Examples include cancer, diabetes, serious heart disease, HIV, sickle cell disease, etc.

As an add-on code, G2211 lets a provider bill for services that go beyond the standard office, home, or telehealth outpatient and management (E/M) visit. On a bill, G2211 is added to the primary E/M code for the visit. A provider can’t submit a bill with only code G2211. It can be used on bills for new and existing Medicare patients. It can’t be used for non-Medicare patients.

Beyond the required services, REHs can provide other outpatient options. These may include behavioral health, rehabilitation, radiology, and additional lab work. REHs can also have a separately run skilled nursing facility unit for short-term care after a hospital stay. They can even serve as a starting point for telehealth visits.

To qualify for REH status, your hospital must have previously been either:

• A critical access hospital (CAH) at least 35 miles from another hospital, with an average acute-care stay of 96 hours or less, no more than 50 inpatient or swing beds, and 24×7 emergency services.
• A subsection (d) rural acute care hospital paid under Medicare’s Inpatient Prospective Payment System (IPPS).

Your facility must also have been participating in Medicare as of December 27, 2020. Once approved, eligible hospitals shift their focus to 24-hour emergency and outpatient/observation services, and stop providing traditional acute inpatient care.