The Centers for Medicare & Medicaid Services (CMS) has posted the revised resource, “How to Use the Office & Outpatient Evaluation and Management Visit Complexity Add-On Code G2211.” The code G2211 reflects visit complexity and increases the value of office and outpatient evaluation and management (E/M) services that are part of a patient’s ongoing health management. Key changes are described below.
Code G2211 with modifier 25
Previously, CMS did not allow payment for G2211 when the associated E/M service was billed with modifier 25. As of Jan. 1, 2025, G2211 is payable even if the base E/M code includes modifier 25, but only when the additional service is an allowed Part B service. See the list of allowed services in Attachment 1 of CMS transmittal 13015. These services include:
- Part B preventive services
- Immunization administrations
- Annual wellness visits
Documentation requirements
Providers must document the medical necessity of both the E/M visit and G2211. This includes detailing the provider’s assessment, plan for the visit, and any other relevant information that supports the use of the code.
These changes aim to better recognize the complexity of primary care services, ensuring appropriate compensation for providers managing patients’ overall health needs. To review other changes to Medicare policies for 2025, see the AASM analysis of the 2025 Medicare physician fee schedule final rule.
Please send any questions regarding the G2211 guidance update to coding@aasm.org.
