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)
This code is currently only for Medicare and Medicare Managed Care beneficiaries. CMS has not limited the use of G2211 to certain specialties but expect it will be used mostly by PCPs. G2211 has been permanently added to Medicare’s telehealth services list.
Medicare is basing the new code on the longitudinal care relationship not the serious or complex condition. They believe this code reflects the time, intensity, and expense required to build longitudinal relationships with patients and address most of their health care needs with consistency and continuity over long periods of time. Do not bill G2211 when modifier 25 is added to the primary E/M code.
G2211 may not be billed with IPPE, AWV, Transitional Care Management, or Chronic Care Management services; office visits where the relationship with the patient is of a discrete, routine, or time limited nature, such as mole removal or referral to a physician for removal of a mole; treatment for a simple virus; counseling related to season allergies; initial onset of GERD; treatment of fractures; where comorbidities are either not present or not addressed; the billing provider has not taken responsibility or does not plan to take responsibility for subsequent, ongoing medical care for that patient with consistency and continuity over time.
Example of G2211:
Established patient visit with a 68-year-old woman on multiple medications who has progressive congestive heart failure (CHF), diabetes, and gout. The physician discusses the patient’s current health issues, which includes confirmation that her CHF symptoms have remained stable for the past three months. She denies having symptoms of hyper- or hypoglycemia but notes ongoing pain in her right wrist and knee. The physician adjusts the dosage of some of the patient’s medications, instructs her to take acetaminophen for her joint pain, and orders laboratory tests to assess glycemic control, metabolic status, and kidney function. The physician also discusses age-appropriate disease prevention with the patient and orders a pneumonia vaccination and colonoscopy screening.
CMS notes that in this example the physician is serving as the focal point for the patient’s care: addressing the broad scope of the patient’s health needs by furnishing care for some or all the patient’s conditions across a spectrum of diagnoses and organ systems with consistency and continuity over time.
Source: Federal Register :: Medicare and Medicaid Programs; CY 2024 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Advantage; Medicare and Medicaid Provider and Supplier Enrollment Policies; and Basic Health Program
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