The landscape of healthcare is evolving, and with it, the need for accurate compensation for the intricate and comprehensive care provided by healthcare professionals. The CPT G2211 add-on code, effective from January 1, 2024, serves as a crucial tool for physicians offering office/outpatient evaluation and management (E/M) services. This guide will walk you through the intricacies of G2211, from its purpose to when and how to use it.

What is CPT Code G2211?

graphic design featuring the HCPCS code G2211,

G2211 is a Healthcare Common Procedure Coding System (HCPCS) add-on code designed to capture the time, intensity, and practice expense resources associated with office/outpatient visits. Specifically tailored for physicians building longitudinal relationships with patients, this code addresses the complexities of primary care and other longitudinal care scenarios. The Centers for Medicare & Medicaid Services (CMS) introduced G2211 to better account for the resource costs linked to the inherent complexity of primary care and other longitudinal care services.

CMS Code Descriptor: G2211

physician updating an Electronic Health Record (EHR)
  • Visit Complexity Definition: Evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services. This includes medical care services related to a patient’s single, serious condition or a complex condition.
  • Billing Information: G2211 is an add-on code, listed separately in addition to office/outpatient evaluation and management visits for both new and established patients.

When to Use G2211:

G2211 becomes payable starting January 1, 2024. Consider using this add-on code when:

  • You are the continuing focal point for all health care services needed by the patient.
  • Your relationship with the patient reflects ongoing medical care with consistency and continuity over time.

Do Not Use G2211 When:

healthcare team engaged in a training session
  • Your relationship with the patient is of a discrete, routine, or time-limited nature.
  • The associated office visit E/M is reported with modifier 25 appended.
  • Reporting CPT code 99211.

Private Payer Considerations:

Private payers are not obligated to cover and pay separately for G2211, and policies may vary. It is recommended to review contracts and discuss with provider relations representatives about including G2211 in the fee schedule.

Medicare Payment Amount for G2211:

As of 2024, the national Medicare allowable for G2211 is $16.04.

How to Start Billing for CPT G2211:

Update Systems:

  • Ensure your EHR and billing systems reflect the 2024 Medicare physician fee schedule.
  • Verify that G2211 is added as part of the updates.

Reporting CPT G2211:

  • Report G2211 with office visits where you assume or intend to assume responsibility for the patient’s ongoing medical care.
  • Do not report G2211 with CPT code 99211 or when the office visit is reported with modifier 25.

Educate Staff:

  • Educate your administration and coding staff on the importance of CPT G2211.
  • Highlight the need for G2211 to accurately reflect the complexity and comprehensive nature of primary care office visits.

Why CPT G2211 is Needed:

A scene from a primary care setting with a diverse group of healthcare professionals collaborating

Studies reveal that primary care office visits involve managing acute and chronic conditions, providing preventive services, counseling, and addressing behavioral health challenges. G2211 is essential to fully account for the added complexity and related practice costs associated with primary care.

Medicare officials acknowledge that existing E/M payments do not fully capture the complexity of care provided by primary care physicians. G2211 addresses this gap by better denoting cognitive services, such as continuous, comprehensive primary care.

Current E/M coding falls short in accounting for the unique services and resources that primary care physicians provide and fails to reflect their extraordinary role in coordinating care for patients.

Embrace G2211 to ensure accurate compensation for the critical and intricate care you provide. Update your systems, understand when to use G2211, and educate your team about its significance. By incorporating G2211, you contribute to a fairer reimbursement model that recognizes the value of primary care in the evolving healthcare landscape.