Beginning January 1, 2024, CMS implemented the separate complexity add-on payment for HCPCS code G2211 for new and established patient office/outpatient evaluation and management (E/M) services.

What is G2211?
HCPCS code G2211 is used for visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed healthcare 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. G2211 should be used as an add-on code that is listed separately in addition to an office visit, outpatient evaluation or management visit. This code can be used for new or established patients. 

What is the purpose of the add-on payment for G2211?
“Generally, it will be applicable for outpatient and office visits as an additional payment, recognizing the inherent costs involved when clinicians are the continuing focal point for all needed services, or are part of ongoing care related to a patient’s single, serious condition or a complex condition,” according to CMS’ Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule.

CMS also stated, “Building an effective longitudinal relationship, in and of itself, is a key aspect of providing reasonable and necessary medical care and will make the patient more likely to comply with treatment recommendations after the visit and during future visits. It’s the work building this important relationship between the practitioner and patient for primary and longitudinal care that has been previously unrecognized and unaccounted for during evaluation and management visits.”

When should a provider use G2211?
According to the American Academy of Family Physicians, “Use the add-on code when you are the continuing focal point for all healthcare 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.”

The AAPC (American Academy of Professional Coders) outlined guidance for using G2211: “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.”

What about the use of Modifier 25 with G2211?
The AAPC states, “Do not bill G2211 when the E/M service is reported with modifier 25 for a procedure rendered by the same provider.”

Additional Resource:

• MLN Matters MM13272: Edits to Prevent Payment of G2211 with Office/Outpatient Evaluation and Management Visit and Modifier 25