The ACR is reaching out to Medicare Advantage and commercial payers to ensure appropriate reimbursement for the new complex care add-on code, G2211.
Medicare implemented the G2211 add-on code Jan. 1 for outpatient office visits to acknowledge the complexity of care for services related to ongoing care, for a patient’s singular chronic or complex condition. After hearing feedback about claim denials, the ACR began outreach to Medicare Advantage and commercial payers to advocate for coverage.
In response to the ACR’s outreach, UnitedHealthcare (UHC) confirmed that its Medicare Advantage claims platform was updated on Jan. 21, 2024, to allow reimbursement for G2211. Similarly, Aetna confirmed that its system was updated on Jan. 28, 2024. Both updates are retroactive to Jan. 1, 2024, and the payers will be reviewing and adjusting claims for any date of service after Jan. 1.
The ACR anticipates that other Medicare Advantage plans will implement similar updates, and outreach is ongoing to confirm these details. If you have questions about a specific Advantage plan, contact [email protected].
In addition, UHC’s commercial platform was updated on Jan. 1, 2024, to allow reimbursement of G2211 on commercial claims. The ACR applauds UHC’s leadership in recognizing the value of this code as an investment in high quality, patient-centered care and will continue to work with other commercial payers to advocate for reimbursement.
For more information or to request ACR assistance with an insurance issue, contact [email protected].
