HCPCS Code G2211: New Guidance for 2024
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As of January 1, 2024, the Office and Outpatient Evaluation and Management (E/M) visit complexity add-on code G2211 became active and is now separately payable under the Medicare Physician Fee Schedule. This code recognizes the cognitive complexity involved in managing long-term care relationships with patients, especially those with complex or serious conditions.
Key Highlights:
- Who Can Use It? Physicians and healthcare providers involved in ongoing patient care for conditions like HIV or chronic diseases. The code applies to all outpatient and office-based E/M visits (CPT codes 99202-99205, 99211-99215).
- Focus on Continuity of Care: G2211 is applicable when the physician serves as the patient’s primary, ongoing care provider and the relationship involves continuous oversight of the patient’s broader healthcare needs.
- Not for Routine Visits: This add-on code is not appropriate for time-limited or routine visits, such as mole removal or minor acute care.
- Billing and Documentation: G2211 can be billed alongside the main E/M code. No additional documentation is required, but records must demonstrate the medical necessity and complexity of the care provided.
Modifier 25 and Billing: CMS has clarified that G2211 cannot be billed on the same day as an E/M visit reported with modifier 25.
For full details and billing guidance, see the MLN Matters article.
