When used correctly, both providers and patients benefit from this add-on code.
The HCPCS Level II add-on code G2211 acknowledges the ongoing relationship between the patient and physician. It also offers additional reimbursement for the extra time and effort required to manage the unique complexities of a patient’s long-term care, including conversations, comprehensive care planning, and collaborative decision-making. In this post, we’ll explore the intricacies of billing this code alongside office and outpatient evaluation and management (E/M) services (CPT® 99202-99215), highlight the changes for 2025, and discuss how to effectively integrate this service into your practice.
Recognizing Relationships
The purpose of G2211 is to compensate physicians and nonphysician practitioners (NPPs) for the time and practice expense involved in building long-term relationships with patients. This visit complexity is not the same as medical decision making, which is used for leveling E/M services. Nor is this visit complexity associated with clinical conditions. For G2211, visit complexity is the cognitive load of the continued responsibility of the physician to provide ongoing care to a patient. The act of proactive and relationship care management that goes beyond acute care is what makes up the visit complexity.
Although G2211 was introduced in 2021, Medicare Part B did not begin reimbursing it until January 1, 2024. Many Medicare Advantage plans have also approved coverage, but coverage varies by plan. Medicaid and commercial payers are not required to reimburse for services associated with G2211. To ensure proper reimbursement, it’s important to regularly review your payer contracts and fee schedules to understand which payers offer reimbursement.
In the 2024 Medicare Physician Fee Schedule (MPFS) final rule, the Centers for Medicare & Medicaid Services (CMS) stated that G2211 would not be reimbursed when the associated E/M visit was reported with modifier 25 (Significant, separately identifiable E/M service). However, after feedback from the medical community, CMS revised its policy in the 2025 MPFS final rule. G2211 will now be reimbursed when the E/M base code (99202-99205, 99211-99215) is reported by the same practitioner on the same day as:
- An initial preventive physician examination or annual wellness visit
- A vaccine administration
- Any other Medicare Part B preventive service
There are no limitations on the frequency with which G2211 can be billed. Any physician or NPP who reports an E/M service in office or outpatient settings is eligible to bill the add-on code G2211. However, G2211 is not payable when provided in a rural health center or federally qualified health center.
Physicians should bill G2211 if:
They provide ongoing care for a serious or complex condition.
They are the primary point of contact for all necessary services, such as a primary care physician.
Documentation Requirements
CMS still has not outlined specific documentation requirements for reporting G2211, but states that medical reviewers will look for documentation that includes:
- The reason for the visit,
- Medical necessity for the E/M service, and
- Medically reasonable and necessary care to support G2211, which may include a detailed medical history, claims history for ongoing diagnoses, assessment and plan details, and other relevant service codes.
Training, Implementation, and Monitoring
To ensure the accurate and effective use of G2211 in a medical practice, a comprehensive approach involving training, implementation, and ongoing monitoring is essential.
- Training: Educate providers on how to properly document the services outlined by G2211. Providers will need guidance on how to capture the complexities of long-term patient relationships in their notes, while coders must be trained to identify eligible visits and ensure that documentation complies with CMS guidelines.
- Implementation: Update electronic health record (EHR) templates and refine workflows to seamlessly integrate the services associated with G2211. It’s important to establish a clear understanding of how to capture the nuances of ongoing relationship-building with patients.
- Monitoring: Establish regular audit intervals to analyze claim patterns, including utilization by provider. Provide feedback to stakeholders to ensure continuous improvement and accuracy.
By incorporating these three key elements, healthcare organizations can fully leverage the benefits of G2211, maintain compliance, and improve patient outcomes.
RESOURCES : Calendar Year (CY) 2025 Medicare Physician Fee Schedule Final Rule | CMS