G2211 Update

As of January 1, 2024, the Centers for Medicare & Medicaid Services (CMS) has implemented a new HCPSC add-on code, G2211.  This is in addition to office and outpatient Evaluation and Management Services (E/M), in an effort to help capture “the inherent complexity of the visit that’s derived from the longitudinal nature of the practitioner and patient relationship.”

At this time, it remains unclear whether other payors will accept this code.  It can be used by any specialty, and can be for new (99202-99205) or established (99211-99215) E/M visits.  This is intended to be used when the clinician is the focal point for all of a patient’s health services needs (eg primary care provider) OR when the clinician is providing (or will be providing) ongoing care for a single, serious condition or complex condition.

G2211 should not be used when there is an acute, time-limited problem, or if the clinician is not going to develop a longitudinal care relationship with the patient.  In addition, this should only be used with an E/M service, and cannot be used together with a modifier 25.  There is no additional documentation required at this time beyond the necessity of the E/M encounter, though there may be some benefit to documentation that reflects the “inherent complexity of the visit derived from the longitudinal nature of the practitioner-patient relationship”.

To date, there is limited guidance from CMS as to the applicability to orthopaedic patients, though the AAOS will be publishing an article in AAOS Now on the topic.  In the orthopaedic oncology practice, MSTS members may frequently be providing “medical care services that are part of ongoing care related to a patient's single, serious condition or complex condition”.  Osseous metastatic disease management and surveillance following sarcoma excision would appear to fit that guidance.  G2211 has a valuation of 0.33 wRVU, which would equate to about $10.80 in a non-GPCI-adjusted CMS reimbursement. 

View 2024 Specialty Day Coding Presentation