On Nov. 1, the Centers for Medicare & Medicaid Services (CMS) finalized its proposal to expand the G2211 add-on code for complexity by allowing providers to be billed when the underlying evaluation and management (E/M) service is performed on the same day as an annual wellness visit, vaccine administration or any Medicare Part B preventive service furnished in the office or outpatient setting. Although the ACR supports this incremental change, we will continue to iterate our desire for the restrictions on modifier -25 to be removed completely.
The CMS created the Healthcare Common Procedure Coding System (HCPCS) code G2211, which is defined as: “Visit complexity inherent to evaluation and management (E/M) 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.”
Below are some facts on G2211 for 2025:
- When modifier -25 can be used: Beginning in 2025, the G2211 code can be used when the same practitioner reports an office or outpatient E/M code on the same day as an annual wellness visit, vaccine administration or Medicare Part B preventive service. This allows providers to bill modifier -25 along with the E/M visit, but only with the procedures identified by the CMS.
- With which E/M codes: The G2211 code can be used with E/M codes 99202–99215.
- What it captures: The G2211 code captures the complexity of the cognitive load of being the focal point for all needed services for a patient.
For hands-on information about billing the CMS add-on code G2211, rheumatology providers can refer to a specialty-specific fact sheet from the ACR and a frequently asked question list from the CMS.
Additionally, the ACR practice management team currently offers a free, tailored, one-hour lunch-and-learn series on coding and compliance for the Medicare code G2211 to ensure billing accuracy with E/M services. The webinar is the latest in a series of resources developed to assist members, practices and their staff with coding updates.
For questions on billing and coding for G2211 or to schedule a lunch-and-learn session for you and your practice, contact the ACR practice management team at [email protected].
