01/15/2024

When Is It Time to Use G2211?

Know when to use this add-on code to capture reimbursement for complex Medicare patient visits.
Beginning Jan. 1, 2024, qualified healthcare providers can bill an add-on HCPCS Level II code to report the extra time, effort, and associated practice expense involved with caring for Medicare patients across the continuum of healthcare.

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).

Consider This
Before you begin to bill for this service, however, there are a few things to consider:

• Providers billing the add-on code are expected to provide longitudinal care to the patient.
  • Providers who do not intend to have an ongoing longitudinal relationship with the patient (e.g., urgent care, consultants, second opinions, etc.) should not bill G2211.
• Primary care physicians and specialists may bill this add-on code.
• Bill G2211 in conjunction with an office or other outpatient evaluation and management (E/M) service.
• Add-on code G2211 may be billed with telehealth services.
• Do not bill G2211 when the E/M service is reported with modifier 25 for a procedure rendered by the same provider.
• Do not bill G2211 when chronic/complex conditions are documented but not considered or addressed in the E/M of the patient.

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