Code G2211 guidance updated by CMS

The Facilities for Medicare & Medicaid Providers (CMS) has posted the revised useful resource, “Methods to Use the Workplace & Outpatient Analysis and Administration Go to Complexity Add-On Code G2211.” The code G2211 displays go to complexity and will increase the worth of workplace and outpatient analysis and administration (E/M) companies which are a part of a affected person’s ongoing well being administration. Key adjustments are described under.

Code G2211 with modifier 25

Beforehand, CMS didn’t enable cost for G2211 when the related E/M service was billed with modifier 25. As of Jan. 1, 2025, G2211 is payable even when the bottom E/M code contains modifier 25, however solely when the extra service is an allowed Half B service. See the record of allowed companies in Attachment 1 of CMS transmittal 13015. These companies embrace:

Half B preventive companies
Immunization administrations
Annual wellness visits

Documentation necessities

Suppliers should doc the medical necessity of each the E/M go to and G2211. This contains detailing the supplier’s evaluation, plan for the go to, and another related data that helps the usage of the code.

These adjustments intention to higher acknowledge the complexity of major care companies, making certain acceptable compensation for suppliers managing sufferers’ total well being wants. To overview different adjustments to Medicare insurance policies for 2025, see the AASM evaluation of the 2025 Medicare doctor payment schedule closing rule.

Please ship any questions concerning the G2211 steerage replace to coding@aasm.org.