Guidance on Use of Healthcare Common Procedure Coding System (HCPCS) code G2211

Healthcare Common Procedure Coding System (HCPCS) code G2211 is an add-on code with the code set of 99211-99215. The intent behind the creation of the G2211 code is to improve patient care and outcomes by better managing serious and complex health issues through a longitudinal care plan. This plan is followed throughout all phases of the patient’s care to improve overall outcomes and quality of care.

Reporting G2211

The relationship between the provider and patient is paramount in deciding whether to report this HCPCS code. You should consider using this code if:

• You are the continuing focal point for all needed services.
• You provide ongoing care for a single, serious or complex condition.

If these criteria do not apply, you should not report G2211.

When reporting G2211, ensure your documentation clearly identifies the history, current treatment plan, goals of care, and any previous episodic similar events with adverse outcomes. You will also want to list any concerns or considerations of the current episode of care. Ensure you continuously update your longitudinal care plan with the patient’s events or episodes. Remember that according to the AMA definition, a problem must be evaluated and treated at the encounter by the provider who is reporting the service and not just pulled forward from a list of previous conditions.

When Not to Report G2211

You should avoid using this code if:

• Your relationship with the patient is of a discrete, routine, or time-limited nature, or comorbidities are not present or not addressed.
• You do not plan to take responsibility for subsequent, ongoing medical care for the patient with consistency and continuity over time.

Additionally, the code is not to be reported if you are billing for other services that would be considered a separately identifiable service and would require reporting a 25 modifier on the office or other outpatient visit, code set 99211-99215. Please note that these guidelines could change in 2025, pending the Medicare fee schedule and Quality Payment Program final rule.

In summary, this code should not be reported for every patient you treat. It is to account for the extra time, effort, and resources that go into building a long-term relationship with a patient and providing consistent care for their healthcare needs.

The CMS G2211 FAQ document and G2211 Reference Card help answer questions related to the use of the add-on code. Contact Yeo & Yeo Medical Billing & Consulting for additional billing and coding guidance.