What to know about the new G2211 procedure code

Learn how, when, and why you should adopt the newly released G2211 procedure code in our short blog.
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By Douglas Swords, CHBME, VP of Revenue Cycle Management at Azalea Health

Introduction to Code G2211

Effective Jan 1st 2024, CMS is activating a new HCPCS add-on code (G2211) to add additional reimbursement opportunities for ongoing complex and continuous care provided in an office or outpatient setting.

G2211 – 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)

The Facts about G2211

  • Reimbursement for HCPCS code G2211 became effective January 1st 2024
  • 2024 Allowable rate for G2211 is $16.05
  • G2211 is an add on code for office visit CPT codes 99202-99215 only

When is it appropriate to bill code G2211?

  • Primary care practitioners who are the main focal point for all needed services
  • Specialty care practitioners providing ongoing care for a single, serious and/or complex condition like sickle cell disease or HIV

When is it NOT appropriate to bill code G2211?

  • For acute ailments that are routine or limited in terms of the length of treatment. 
  • Providers not assuming responsibility for subsequent, ongoing medical care over a continuous course of time
  • G2211 can not be billed alongside E/M codes appended with a 25 modifier.  See CMS MLN Matters Number: MM13272 for further explanation

What are the documentation requirements for G2211 reimbursement?

Per CMS MLN Matters Number: MM13473 (page 3) there are no additional documentation requirements, however, the reason for the E/M visit must be clearly documented along with the medical necessity, time spent, diagnosis, assessment and plan.

Is G2211 limited to primary care specialties?

According to MLN Matters Number: MM13473 Any medical professional who can bill for office and outpatient E/M visits qualify for billing G2211 “regardless of specialty”.

Will patients have out off pocket expenses for G2211?

Yes, both coinsurance and deductibles apply for G2211.

Can Telehealth visits be billed with G2211?

G2211 can be billed with E/M CPT codes 99202-99215 which includes services provided via telehealth. Medicare added G2211 to the List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth.

How can I start billing for G2211?

  • Ensure G2211 is available in your EHR system and that you have it loaded in your fee schedules and/or charge masters.
  • Educate providers, billing and admin staff on requirements for G2211, including how to identify patients who qualify, documentation requirements, and billing requirements.

Can G2211 be billed by Rural Health Clinics (RHC)?

RHCs can bill for G2211 but will not receive any additional reimbursement. It will increase the out of pocket copayment amount for the patient or secondary payer.

How can I start billing for G2211?

CMS Resources on G2211

Reference Links