The provision of longitudinal care is the crux of family medicine and represents the ongoing relationship between patients and their physician. Healthcare Common Procedure Coding System (HCPCS) add-on code G2211 recognizes the value of office and outpatient evaluation and management (E/M) services that are part of a patient’s ongoing health management. According to the American Academy of Family Physicians (AAFP), 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.
Proper use of the G2211 code in healthcare billing is essential to maximize its benefits. Leveraging medical coding services can help providers navigate the complexities of billing this code along with office and outpatient evaluation and management (E/M) services (CPT codes 99202-99215).
Understanding Code G2211
Though CMS created G2211 in 2021, the code was implemented as a reimbursable service on Jan. 1, 2024. Medicare Part B and many Medicare Advantage plans cover the services represented by this add-on CPT code. Medicaid and commercial payers are not required to pay for it.
CMS defines G2211 as follows
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)
The AAFP points out that this definition has two key aspects. First, G2211 is based on the clinician’s ongoing responsibility for the patient, not the patient’s condition. Second, it recognizes that a long-term relationship can exist for a single serious or complex condition, even if the clinician is not managing all of the patient’s care. CMS provides the example of a patient with HIV who receives ongoing care from an infectious disease specialist.
- G2211 add-on code was introduced to account for the complexity of a clinician’s ongoing relationship with a patient, beyond what standard E/M codes capture.
- G2211 can be added to office/outpatient E/M visits (99202-99205, 99211-99215) when the clinician maintains continued responsibility for the patient, regardless of the patient’s specific condition.
- Even if the clinician does not oversee all aspects of the patient’s care, G2211 may still apply when managing a single serious or complex condition over time.
Using G2211
- When to Use G2211 add-on code for E/M visits
Any physician or NPP who reports an E/M service can use add-on code HCPCS code G2211 in office/outpatient settings. On January 1, 2025, CMS updated the rules for using G2211, allowing payment for G2211 even when the base E/M code (99202-99205, 99211-99215) is appended with modifier 25, provided the service requiring modifier 25 is a Part B service. Specifically, the 2025 MPFS final rule allows payment for G2211 when E/M code is reported by the same practitioner on the same day as:
- An initial preventive physician examination or annual wellness visit,
- A vaccine administration, or
- Any other Medicare Part B preventive service
Here are the basic guidelines on using G2211:
Applicable Visits: G2211 can only be added to new or established patient office/outpatient E/M codes (99202-99205, 99211-99215).
Selection Criteria: It applies regardless of whether medical decision-making (MDM) or time is used to determine the E/M service level.
Chronic and Acute Care: G2211 can be used for chronic or acute care visits, with no minimum number of chronic conditions required, as long as a longitudinal relationship exists or is expected.
New Patient Eligibility: A new patient visit qualifies if they will be establishing with the clinician as their medical home.
Established Patient Eligibility: An acute care visit with an established patient qualifies if the clinician’s practice remains the central point for the patient’s ongoing healthcare needs.
Practices delivering team-based care can use G2211 if they act as the central point for care coordination or provide ongoing specialized care.
Note: G2211 cannot be billed independently and must be reported alongside an office and outpatient E/M code on the same day of service. There are no restrictions on the frequency with which G2211 may be billed.
- When not to use G2211: AAFP states that this add-on code should not be used 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”.
This this add-on code should not be used if a patient is seen for a second opinion and a follow-up visit is not scheduled.
Do not use the code if a separate billable procedure is done on the same day of the visit with a modifier 25.
G2211 is not payable when furnished to a patient in a rural health center or federally qualified health center.
Example of correct G2211 usage for clinicians
A 65-year-old Medicare patient with an established history of diabetes, hypertension, and hyperlipidemia visits for a routine check-up. The physician orders an A1C test, comprehensive metabolic panel, lipid panel, and urine microalbumin test, and adjusts the patient’s blood pressure medication. This visit qualifies for a 99214 E/M code along with the G2211 add-on code, as the physician has an ongoing relationship with the patient and continues to manage their long-term care.
To bill HCPCS code G2211:
- Update Systems: Ensure your EHR and billing systems reflect the 2025 Medicare physician fee schedule.
- Verify Code Availability: Confirm with your medical billing staff that G2211 is included in system updates.
- Inform Patients: Since deductible and coinsurance apply, inform patients that there may be an additional charge.
- Report G2211: Use code G2211 for office visits when assuming or planning to assume ongoing care for the patient.
- Educate Staff: Train administrative and coding teams on the importance and proper use of G2211.
G2211 Documentation Requirements
Though there are no official documentation requirements for reporting G2211, CMS states that medical reviewers will look for the following in the documentation:
- Reason for the visit
- Medical necessity for the E/M service
- Supporting details for G2211, such as a comprehensive medical history, claims history for ongoing conditions, assessment and plan details, and relevant service codes.
The visit documentation for the primary E/M service should also clearly indicate that the practitioner is the main provider managing care for a single, serious condition or a chronic condition.
Value of Expert Billing and Coding Support
Proper documentation, combined with medical coding outsourcing to an expert can ensure best practices for billing G2211 correctly.
Physicians must thoroughly document the services covered by G2211 to support its use. With precise documentation, expert coders can identify eligible visits and ensure medical coding compliance with CMS guidelines. By correctly applying this add-on code alongside E/M services, coding specialists help clinicians maximize reimbursement for high-value patient visits. Additionally, they regularly review payer contracts and fee schedules to determine which payers reimburse for G2211, ensuring providers receive the payments they deserve.
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