- Admission and Discharge Services
- Advanced Care Planning
- Behavioral/Mental Health Services
- Chronic Care Management
- Complex and Chronic Care - HCPCS Code G2211
- Consultations
- Critical Care Services
- Documentation
- Emergency Department
- Examination
- Fee-For-Time Compensation Arrangements
- General E/M Information
- Global Period Services
- History
- IPPE and AWV Services
- Medical Decision Making
- New vs. Established Patients
- Nonphysician Practitioner Services
- Observation Services
- Preoperative Clearance
- Prolonged Services
- Provider Specialty
- Scribes
- Separately Identifiable Service
- Skilled Nursing Facility Services
- Smoking Cessation
- Split/Shared and Incident To Services
- Teaching Environment E/M Services
- Telehealth Services
- Time-Based Services
- Transitional Care Management
- Urgent Care
Complex and Chronic Care - HCPCS Code G2211
- Please define appropriate usage and billing for HCPCS code G2211.
Answer: CPT G2211 is an approved add-on code representing complex and/or continuous management in the office and outpatient environment. It may be added to E/M services (99202-99205 and 99211-99215) when no modifier 25 has been added to the claim. The exception to this rule is that G2211 may be added to claims on which a modifier 25 has been added to an approved Medicare preventive service.
- Please define the meaning of “longitudinal relationship” in relation to G2211.
Answer: Based on recent CMS guidance, the term “longitudinal” in reference to G2211 means that the provider, whether in a new or subsequent episode of care, is establishing or continuing a relationship with the patient that is expected to be of significant duration. The reasons for the expected continuation of care may include the context of a primary care setting or may apply to specialty care for a serious or complex condition, that will be provided over an extended period. An isolated service to address a simple or self-limiting condition would generally not qualify as longitudinal care.
G2211 may be used for new patient visits when it is expected that additional visits to treat or follow the patient’s condition(s) will be necessary.
- Please explain any limitation on the type of provider who may consider use of G2211 with E/M service.
Answer: G2211 may be added to claims for E/M services by all provider types (physicians and NPPs) who are currently permitted to perform and bill for E/M services.
- Please define the E/M CPT services with which G2211 may be used.
Answer: As of 2/1/2024, CMS has limited use of G2211 to claims for E/M services 99202-99205 and 99211-99215. CMS has confirmed that G2211 may not be used with any other correlative E/M services.
- Please define a situation in which G2211 may be used with E/M 99211, which does not require personal physician participation.
Answer: G2211 may be used with 99211 when the service performed is part of a longitudinal period of care for a complex or chronic condition. So, for example, a blood pressure check by an office nurse, in the context of a course of care for uncontrolled hypertension, may warrant G2211.
- Please define any limitation on the frequency or duration at which G2211 may be added to E/M claims.
Answer: There are no frequency or duration limitations on G2211. Medical necessity is the primary factor in considering the use of this code; the medical record must support the key elements of the code’s definition and requirements.
- Please define the POS limitations for G2211.
Answer: G2211 usage is limited to claims for E/M services performed in the office (POS 11) and outpatient (POS 19 and POS 22) settings. CMS has confirmed that G2211 is not applicable to services in the FQHC setting, where it is considered an informational-only modifier. - May G2211 be added to an E/M claim on which a prolonged service code has also been included?
Answer: CMS has not precluded use of G2211 on an E/M claim that includes a prolonged service code. These add-on codes represent different facets of a given service. The prolonged service code defines additional time needed to complete an E/M service, which does not necessarily represent the complexity of the service. The G2211 does reflect complexity of care for chronic or serious conditions and is not related to time spent in the service.
- Is G2211 payable when services 99202-99215 are performed via telehealth?
Answer: Yes, G2211 may be payable when any of the above services are performed via telehealth.
- Is G2211 payable to a provider who is also performing chronic care management services for the same patient?
Answer: Yes, G2211 is payable for patients also receiving chronic care management services.
- May G2211 be billed with E/M services performed on an incident to basis?
Answer: Yes, this is permissible.
Reviewed 1/24/2025