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Key Takeaways
- G2211 is an HCPCS Level II add-on code that describes the complexity of a long-term, ongoing care connection. Since January 1, 2024, Medicare has paid this code individually.
- Base codes that can be used are 99202 to 99214 for office/outpatient E/M services and, starting January 1, 2026, 99341 to 99350 for home and residence E/M services.
- You can’t bill G2211 when modifier 25 is on the claim unless the same-day service is an annual wellness visit, giving a vaccine, or a Medicare Part B preventive service (this rule has been in place since January 1, 2025).
- In 2026, Medicare will pay $17.37 for non-facility visits and $14.36 for facility visits across the country, before any geographic adjustments are made. The plan includes a deductible and 20% coinsurance.
- On January 1, 2027, G2211 will become modifier B1, which will raise payment by 16% of the E/M base. For MSSP ACO and LEAD model clinicians, an optional modifier B2 will raise payment by 32%.
You can bill G2211 along with an office/outpatient or home E/M visit if you’re the patient’s main source of care or if you handle a dangerous or complicated condition over time. On the same day, service must be an annual wellness visit, vaccine administration, or Medicare Part B preventive service. Otherwise, you can’t bill it as one-time or short-term care or with modifier 25.
What Is the G2211 Code?
G2211 is not a CPT code, even though people often search for it as a “G2211 CPT code.” This is because, unlike CPT codes released by the AMA, CMS creates and maintains HCPCS Level II codes. G2211’s official description is: “Visit complexity inherent to evaluation and management 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 or complex condition.”
CMS made G2211 in the CY 2021 PFS final rule, but it was originally called GPC1X. They did this because standard E/M valuations don’t account for the work of keeping a patient’s care ongoing, ensuring they have what they need, and managing serious or complicated conditions over time. Because of worries about the PFS conversion factor, Congress put a hold on payment for the code until January 1, 2024. Long-term care and primary care specialists couldn’t bill for the relationship itself; they could only bill for the visit until payment finally became possible.
Since launch, the code has been changed twice. Starting January 1, 2026, CMS added home and residence E/M services to the list of eligible base codes. On January 1, 2027, CMS will replace the code completely with modifier B1. The main goal of these changes is the same: pay for ongoing, organized care instead of one-time visits.
When You Can Bill G2211
Five things must be true before you can add G2211 to a claim. If any of them doesn’t work, the code doesn’t belong on the bill.
- The base code is eligible. Codes 99202, 99203, 99204, and 99205 are for office or outpatient visits. Codes 99211, 99212, 99213, and 99215 are for visits by regular patients. From January 1, 2026, E/M numbers 99341, 99342, 99344, 99345, 99347, 99348, 99349, and 99350 for homes and residences will also be valid. G2211 cannot be added to E/M numbers for inpatients, the emergency room, or care homes.
- A longitudinal care relationship exists. CMS says that this means either the practitioner is the ongoing point of contact for all necessary health care services or the practitioner provides ongoing care for a single serious or complex condition. Visits that are sudden, short-term, or one-time do not qualify. The connection must be ongoing, not a one-time visit.
- Any specialty can bill it. The code isn’t just for basic care. To qualify, a cardiologist treating chronic heart failure, an infectious disease doctor treating HIV, or an endocrinologist treating complex diabetes must provide ongoing care. Nurse practitioners and physician assistants who care for long-term patients on their own can also bill it.
- The payer recognizes it. G2211 is a Medicare number. If you’re billing someone else, check their fee schedule or policy first. Attach it to a business claim only after you’re sure the provider will accept it.
- Modifier 25 is not on the claim, with one exception. If modifier 25 is present because the procedure was done the same day, G2211 is not paid separately. As of January 1, 2025, one exception remains: G2211 can still be paid if modifier 25 is on the E/M because of an annual wellness visit (AWV), vaccine treatment, or another Medicare Part B prevention service on the same date. The exception is not very big. It doesn’t cover other kinds of procedures.
What Counts as a Longitudinal Relationship?
CMS chose its words carefully: the relationship can’t be “discrete, routine, or time-limited.” A practitioner has a longitudinal relationship with a patient when they are responsible for their health over time, not just for one problem. This includes primary care doctors who serve as the patient’s medical home, internists who manage multiple chronic conditions, and specialists who treat one serious condition long term, rather than specialists who see the patient only once or for a set period after surgery.
For legal reasons, the note should show that the relationship is ongoing and list the conditions that were managed over time, the care plan, and the practitioner’s role. CMS has not released a separate documentation checklist for G2211 on top of the normal E/M documentation needs. However, notes showing the relationship protect the claim during an audit.
When You Can’t Bill G2211
Modifier 25 With a Procedure
The most common reason for denial is when a doctor does a minor procedure during the same visit, like a joint injection, mole removal, or suture removal, and adds modifier 25 to the E/M to show the visit was clearly separate. In that case, G2211 is not due. The exception for modifier 25 applies only to health visits and preventive activities that occur once a year. It doesn’t cover visits on the day of the treatment, even if the patient has other complicated long-term illnesses.
Discrete, Time-Limited, or One-Time Care
Consultations that happen only once, emergency room trips for an infection with no follow-up plan, or post-surgery visits where the doctor’s role is limited to that surgery do not meet the longitudinal-care standard. It’s not about how complicated a single visit is in G2211. It’s about relationships. Making difficult medical decisions isn’t enough to make a visit eligible.
Ineligible Settings
Base codes for emergency rooms (99281–9285), nursing homes, inpatient E/M codes (99221–9223, 99231–99233, 99238–99233), and emergency rooms (99221–9223) are not valid. In those situations, you don’t have to pay extra for G2211. Additionally, FQHCs and RHCs can’t bill for it separately either. They are paid based on encounters (the FQHC prospective payment system or the RHC all-inclusive rate), so the add-on is paid as part of the overall payment rather than as a separate item.
No Established Ongoing Role
A doctor seeing a patient for the first time with no plans for ongoing care, a covering doctor filling in for the patient’s regular doctor, or a doctor addressing a narrow referral question with no long-term involvement does not establish the focal point or ongoing condition relationship CMS requires. The duty has to be real, not just assumed.
G2211 Examples: Bill It or Not?
| Scenario | Bill G2211? | Why |
| PCP managing diabetes and hypertension at a regular follow-up | Yes | Longitudinal relationship, eligible base code, no procedure |
| Same PCP, same day also delivers AWV with modifier 25 | Yes | Modifier 25 exception applies for AWVs since January 1, 2025 |
| Same PCP, same day removes a skin tag, modifier 25 on E/M | No | Modifier 25 with a procedure blocks G2211 |
| Urgent care physician treating sinus infection, new patient, no follow-up plan | No | Discrete, time-limited care; no longitudinal relationship |
| Infectious disease physician managing HIV across regular visits | Yes | Ongoing care for a serious or complex condition |
| Dermatologist removing a mole, one-time visit | No | Procedure with modifier 25; no ongoing care relationship |
| Cardiologist managing heart failure over multiple visits | Yes | Ongoing care for a serious condition; specialist is eligible |
| PCP conducting a home visit for a homebound patient in 2026 | Yes | Home E/M code eligible since January 1, 2026 |
| Hospitalist managing an inpatient admission | No | Inpatient E/M codes are not eligible base codes |
| Telehealth follow-up for an established patient with complex chronic conditions | Confirm with payer | CMS FAQ confirms telehealth eligibility; verify place-of-service rules with your MAC |
How to Document G2211
CMS doesn’t provide a separate documentation checklist for G2211. The standard requirements for E/M documentation are met. The claim is protected by a note showing the ongoing relationship: the practitioner’s role in the patient’s care, the condition(s) managed over time, and a plan that extends beyond the visit.
When auditors review G2211 claims, they want proof the add-on is justified, not just a guess. People will notice copy-and-paste template notes that say “serving as the focal point for all needed services” without giving any clinical context. Show it in the note, don’t just write it.
Do not charge G2211 for every visit just because there is a longitudinal relationship. The visit itself still needs to show how hard and important the extra is to justify it. A quick 99212 replacement for a healthy patient who hasn’t been in the office in a year may not justify the add-on, even if the friendship meets the requirements.
G2211 Payment, RVUs, and Patient Cost-Sharing
The work RVU for G2211 is 0.33. At a 2026 conversion rate of $33.4009, the national salary is $17.37 for an office setting and $14.36 for a hospital setting, before any changes to the geographic practice cost index (GPCI). Your actual reimbursement will depend on where your MAC is located. You can find your rate with the CMS Physician Fee Schedule Look-Up Tool.
Cost-sharing for patients is used. The Medicare Part B deductible and 20% coinsurance apply to G2211, the same as they do for the base E/M service. People who haven’t met their deductible yet also owe their share of the add-on. Giving customers this information up front keeps the front desk from dealing with payment issues.
For primary care billing practices billing G2211 at scale, the add-on adds roughly $17 per qualifying visit nationally. At 100 qualified contacts per month, that’s an extra $1,700 in income before regional adjustments are made. That’s not small, which is why capture rates matter.
Is G2211 Only for Medicare?
CMS made G2211 only for the Medicare Physician Fee Schedule, which means Medicare trusts it most. That includes both regular Medicare Part B and, a lot of the time, Medicare Advantage plans, though the contracts for Medicare Advantage plans are different. A few Medicare Advantage plans have their own fee schedules that might not match the PFS dollar for dollar. Before billing, check the individual MA plan’s rules.
Some state Medicaid programs accept G2211, but not all cover it. Most commercial payers still don’t know what the code means. A payer will deny it if you try to bill G2211 when it isn’t on its fee plan. Before adding G2211 to a claim that isn’t for Medicare, check the payer’s published fee schedule or call the payer directly to make sure.
Common G2211 Denials and How to Fix Them
Modifier 25 edit. Most of the time, this is the G2211 rejection. If modifier 25 is on the E/M because of a same-day procedure, the payer system will automatically either bundle the add-on or deny it. If the same-day service was an AWV, vaccine, or Part B prevention, you should file an appeal with the necessary paperwork and CMS transmittal R13015OTN (CR 13705). It’s right to say no if it was a procedure.
Add-on billed without an eligible base code. G2211 cannot stand alone. As a valid office/outpatient or home E/M base code, it must show up on the same claim, on the same date of service, and from the same provider. When the base code is on a different line, date, or provider’s NPI, the add-on will be refused.
Ineligible place of service. Claims sent from an inpatient unit, an emergency room, or a nursing home will be denied. Before you send in the claim, make sure you check the place-of-service code. Review your internal denial management process for denial codes and rework workflows to catch POS errors before you submit the claim.
For recurring modifier XU and edit-related denials across your E/M coding, a systematic coding audit is usually more efficient than claim-by-claim rework.
What Changes in 2027: G2211 Becomes Modifier B1
CMS released the final rule for the CY 2027 PFS on November 4, 2026. Starting January 1, 2027, two new HCPCS modifiers will be used instead of G2211.
Modifier B1 is commonly used instead. Instead of a flat extra amount, it adds 16% to the base E/M code price. Anyone who currently bills G2211 can use B1 as long as they meet the same requirements.
Modifier B2 is optional and available only to clinicians in the LEAD model or a Medicare Shared Savings Program (MSSP) ACO. It increases payment by 32% of the base E/M payment to reflect the additional infrastructure these models need to coordinate care.
Because the one-year 2.5% congressional increase ends, the 2027 conversion factors are $32.95 for participants in the qualifying APM and $32.63 for participants in the non-qualifying APM. These are both slightly lower than the 2026 factors.
Illustrative impact by E/M level (non-facility, national rate, 2027 non-qualifying APM CF $32.63):
| E/M Code | 2026 Base Payment | G2211 Add-On (2026) | Total (2026) | 2027 Base (est.) | B1 at +16% | Total (2027 est.) |
| 99212 | $59.45 | $17.37 | $76.82 | ~$57.70 | ~$9.23 | ~$66.93 |
| 99213 | $95.19 | $17.37 | $112.56 | ~$92.40 | ~$14.78 | ~$107.18 |
| 99214 | $138.44 | $17.37 | $155.81 | ~$134.37 | ~$21.50 | ~$155.87 |
| 99215 | $186.07 | $17.37 | $203.44 | ~$180.60 | ~$28.90 | ~$209.50 |
The real-world impact depends on the visit level. Visits with more complex information (99214, 99215) stay about the same or slightly better than expected under B1. Because the flat $17.37 add-on under G2211 was proportionally bigger than the base payment, visits with lower complexity (99212, 99213) may see a small net decline. For practices that bill a lot at lower levels, the change calls for a revenue projection before January 1.
What to do before January 1, 2027:
Change the G2211 modifier in your EHR charge capture and charge master to B1 (or B2 if your practice is in a qualifying MSSP ACO or LEAD plan). Train coders and billers on how to use the modifier format. Check with your program supervisor to see if you are an ACO and if B2 may apply. Plan to closely monitor January claims for modifier changes that weren’t possible with the add-on code style.
FAQs
What is procedure code G2211?
G2211 is an add-on code for Medicare HCPCS Level II visits that are more complicated because they are part of long-term care. It’s billed along with an office or home E/M service by any doctor who is the patient’s main point of care or who manages a serious or complicated condition that lasts for a long time. On January 1, 2024, it became due on its own.
When should G2211 not be billed?
You shouldn’t have to pay G2211 for one-time appointments, urgent care visits, or any other private, regular, or time-limited care. You also can’t pay it if modifier 25 is on the claim because of same-day treatment, the visit uses an invalid setting code (like hospital, ED, or care home), or the payer doesn’t understand the code.
Can you bill 99213 with G2211?
Yes. You can add G2211 to any valid office or outpatient E/M code, like 99212, 99213, 99214, or 99215. The visit’s level of difficulty doesn’t affect whether the person can get the add-on. The relationship between longitudinal care does.
Which insurances pay G2211?
Medicare Part B does not pay G2211. A lot of Medicare Advantage plans do too, but the rules are different for each plan, so check the fee list for that plan. Currently, most Medicaid and private payers do not recognize the code. Before billing, make sure that any non-Medicare payer will cover the costs.
Is G2211 only for Medicare?
The Medicare Physician Fee Schedule is what G2211 was made for, so Medicare is the most reliable payer. Medicare Advantage plans don’t have to follow Medicare’s coding rules, but they usually do. Most commercial payers don’t cover it. It’s been used in some state Medicaid systems but not in others. Check with each payer before sending.
Can specialists bill G2211?
Yes. CMS makes it clear that specialists can bill G2211 when they treat a serious or complex condition over time. A doctor of infectious diseases who treats HIV, a rheumatologist who treats lupus, or a cardiologist who treats advanced heart failure over a number of visits all qualify. The important thing is that the specialist’s job is ongoing, not just sometimes.
Can G2211 be billed with telehealth visits?
CMS says G2211 can be paid for video E/M services as long as the visit follows place-of-service rules and the base code is valid. Check with your MAC about the exact place-of-service code, as telehealth billing rules vary by state and coverage period. Use telehealth modifier 95 correctly on those claims.
Can G2211 be billed with modifier 25?
If modifier 25 is on the E/M, it means the same practitioner also provided an annual wellness visit (AWV), a shot, or another Medicare Part B preventive service on the same date. This exception has been in place since January 1, 2025. If modifier 25 is there because of a procedure (like an injection or small surgery), G2211 is not due.
How much does Medicare pay for G2211?
Before adjustments for geography, Medicare gives $17.37 (non-facility/office) and $14.36 (facility) across the country in 2026. RVU for the work is 0.33. The amount you actually get paid depends on the GPCI in your MAC area. Patients must pay the deductible plus a 20% coinsurance as required by Part B.
What happens to G2211 in 2027?
From January 1, 2027, modifier B1 will be used instead of G2211. B1 takes the place of the standard flat add-on and adds 16% to the E/M base price. For doctors who work in MSSP ACOs or the LEAD plan, the optional modifier B2 adds 32%. Because of the change, EHR and charge master must be updated before January 1.
Conclusion
One of the few Medicare add-on codes that directly rewards keeping a patient over time is G2211. Its catch rate still has a lot of room to grow across all qualified offices. When home visits were added in 2026, the code could cover more types of meetings. When modifier B1 was added in 2027, it changed both the format and the payment math. It’s worth the work to get this done before January 1.
There may be money waiting to be made if your practice bills a lot of E/M and you haven’t checked your G2211 capture or denial patterns. Our medical coding services team audits E/M and G2211 coding across your encounter data to find both undercoded visits and denial patterns, so you’re protected on both sides.
