How to Use Code G2211

HCPCS code G2211 is an add-on code designed to better capture the “...visit complexity inherent to office/outpatient E/M visits 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" [cms.gov].

In layman’s terms, that means it provides additional reimbursement for seeing chronic, complex medical conditions.

It was designed to encourage longitudinal relationships between patients and providers by recognizing the additional time, intensity, and resources required to care for patients with chronic and/or complex conditions, with a focus on proactive management, coordinated care, and a holistic approach.

Despite being established by CMS on January 1, 2021, it finally went into effect on January 1, 2024.

So, is it worth it?

Well, G2211 has an estimated (check with your billing department) work RVU of 0.33 (and a total RVU of 0.49). These codes are added on to baseline E&M service codes (for instance, 99202 - 99215), so how much its worth will depend on one’s own clinical volume and patient panel.

For me? I do use it. I estimate that I see ~20 patients per week. If we assume half of them meet criteria for G2211, that would then mean:

0.33 RVUs x 10 patient = 3.3 RVUs per week (or 158.4 RVUs per year)

And at $60 per RVU, that amounts to an additional $9,504 per year. YMMV.

Here’s how to code for it and not be rejected.

Step 1: Ensure You’re Treating a Chronic or Complex Condition

Chronic conditions include things like diabetes and heart disease. Complex conditions include things like cancer, rheumatological, or autoimmune disease. Acute conditions, such as sinusitis, can also count, provided the physician has an ongoing, presiding relationship with that patient’s medical care (such as a primary care physician).

Step 2: Ensure You Have an Ongoing, Longitudinal Relationship with the Patient

In practice, this means there are plans for the patient to return for follow-up. You cannot code G2211 if there are no planned follow-ups. Best practice is for the follow-up to be in 12 months or less. G2211 should not be used if the condition is transient or self-limited.

Step 3: Ensure You Are the Focal Point for Managing That Condition

Meaning, you are responsible for the follow-up, whether that includes surveillance labs and imaging, or prescription medication management.

Then, just document each criteria as such. Here’s an example, which can be turned into a dot phrase to streamline documentation:

I am the primary manager of this patient’s [medical condition], which is a chronic, complex medical condition that has been followed longitudinally under my care.

Step 4: Attach the G2211 Add-On Code

Enough said

So to summarize, to attach a G2211 add-on code, the following criteria must be met:

• You need to have a longitudinal relationship with a patient.
• That patient needs to have a single, serious, or complex condition.
• You need to be the focal point for managing that condition.
• You need to attach the G2211 add-on code.