G2211 Add-on Code: What It Is and When To Use It

Reprinted from AAFP:  https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/evaluation-management/G2211-what-it-is-and-how-to-use-it.html

The care you provide your patients is complex and comprehensive. G2211 will help you get paid more accurately for it. Starting January 1, 2024, use this new add-on code alongside office/outpatient evaluation and management (E/M) codes to receive additional payment for the high-value visits you provide.

What is G2211?

Healthcare Common Procedure Coding System (HCPCS) add-on code G2211 reflects the time, intensity, and practice expense resources involved when physicians provide office/outpatient visits that build longitudinal relationships with patients and address the majority of a patient’s health care needs with consistency and continuity over longer periods of time. The Centers for Medicare & Medicaid Services (CMS) created code G2211 to better account for the resource costs associated with visit complexity inherent to primary care and other longitudinal care.

CMS 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 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)

When to use G2211

HCPCS code G2211 is payable starting January 1, 2024. G2211 is an add-on code that may be reported with new and established patient office/outpatient evaluation and management (E/M) services. Use the add-on code when you are the continuing focal point for all health care services the patient needs. Per CMS, the relationship between the patient and the physician is the determining factor of when the add-on code should be billed.  

Do NOT use G2211 when: 

• Your relationship with the patient is of a discrete, routine, or time-limited nature. For example, a physician who sees a patient for an acute concern should not report HCPCS G2211 if they have not also assumed responsibility for the patient’s ongoing medical care or do not plan to take responsibility for subsequent, ongoing medical care with consistency and continuity over time. 
• The associated office visit E/M is reported with modifier 25 appended. 
• Reporting CPT code 99211.

Do private payers pay for G2211?

Private payers are not required to cover and pay separately for G2211, and their policies will vary. The AAFP encourages you to review your contracts and speak with your provider relations representatives about adding G2211 to your fee schedule. The AAFP is strongly advocating that private payers cover and pay for G2211 across all lines of business.

Additional information regarding the AAFP’s advocacy efforts can be found on the Decoding G2211: Myths Versus Facts webpage.

Medicare payment amount for G2211

The 2024 national Medicare allowable for G2211 is $16.04.

How to start billing for G2211

• Update your EHR and/or billing systems to reflect the 2024 Medicare physician fee schedule.
  • Verify G2211 is added as part of the updates. Usually practice management or billing and coding staff can help with this.
• Report HCPCS code G2211 with office visits where you have assumed or intend to assume responsibility for the patient’s ongoing medical care.
  • G2211 should not be reported with CPT code 99211 or when the office visit is reported with modifier 25.
• Educate your administration and coding staff about the importance of G2211. Let them know that:
  • Studies show that primary care office visits are more complex than those conducted by other specialties. Primary care physicians pack highly complex care into brief visits by managing all a patient’s acute and chronic conditions, providing ongoing preventive services, and counseling, and addressing behavioral health challenges and unmet social needs. To fully account for this additional complexity and related practice costs, G2211 is needed. 
  • Medicare officials agree that updated office visit E/M payments do not fully account for the more complex, whole-person care provided by primary care physicians. Existing coding processes are better at denoting procedures than at describing cognitive services such as continuous, comprehensive primary care.
  • Current E/M coding fails to account for many of the unique services and resources that primary care physicians provide or reflect their extraordinary role in coordinating care for their patients. The typical primary care physician caring for Medicare patients must coordinate care with 229 other physicians working in 117 practices.