In 2024 The Centers for Medicare and Medicaid Services (CMS) rolled out an add-on code which will be very useful for specialties that rely on evaluation and management services when caring for patients. This code has one of the longest official descriptions but when examined is not overly complex and will help to increase revenue for Medicare and Medicare Advantage patients for services are already being performed.
Official Description for 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)”
The code G2211 takes into account an ongoing relationship with the patient for a medical need and is billable in addition to the Evaluation and Management Service. Depending on geographic location the reimbursement from Medicare will be around $16 in additional allowable payment for a physician.
This code is to be billed in addition to the evaluation and management service and can be performed via telehealth. If there are other procedures performed on the same day in addition to the evaluation and management service this service is not billable. Documentation should include clear direction demonstrating patient return and continued care for the patient and or condition.
Items to keep in mind:
- Do not report with Modifier 25 on the Evaluation and Management Service.
- If a procedure is also performed this service is not payable.
- Covered by Medicare and Medicare Advantage plans.
- Documentation should include clear direction demonstrating patient return and continued care for the patient and or condition.
For assistance or questions with billing G2211 please contact us at (800)734-7486 or use the form below.