Oasis Medical Solutions
April 28, 2025

Understanding and Using Procedure Code G2211: 

In today’s evolving reimbursement environment, staying current with coding updates is critical for healthcare practices and billers. One significant change is the expanded use of HCPCS Level II add-on code G2211, which recognizes the cognitive work involved in managing ongoing patient relationships.

Procedure code G2211 is a crucial billing code healthcare practices must understand to ensure full Medicare reimbursement and proper documentation of longitudinal patient care. Using G2211 appropriately helps ensure fair provider compensation, accurate billing, and better patient outcomes.

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What G2211 Represents: Capturing the Complexity of Long-Term Care

G2211 acknowledges the additional effort providers invest when managing a patient’s health over time, beyond making decisions for a single visit. It captures the longitudinal relationship, including:

  • Long-Term Care Planning: Developing and updating care plans for chronic conditions and health goals.
  • Collaborative Decision-Making: Engaging patients (and families, when appropriate) in healthcare choices over time.
  • Communication Between Visits: Addressing patient needs through phone calls, emails, or patient portals.
  • Care Coordination: Collaborating with specialists and community resources to ensure seamless care.
  • Data Review and Interpretation: Analyzing medical history, past treatments, and test results to inform ongoing care.

Importantly, G2211 is not tied to the severity of a patient’s acute condition or the E/M medical decision-making level.
Instead, it reflects the cumulative cognitive load of maintaining a continuous relationship with the patient.

Billing and Coding Guidelines: How to Use G2211

CMS has not issued separate documentation requirements for G2211. However, your E/M documentation must naturally support the need for it. Focus on showing:

  • Purpose of the Visit: A clear reason for the encounter.
  • Medical Necessity: Proper justification for the billed E/M level.
  • Ongoing Relationship Evidence: Implicit support for G2211 through:
    • A detailed patient history showing continuity of care,
    • References to the patient’s chronic diagnoses and treatment planning,
    • Comprehensive assessment and plans addressing long-term management,
    • Notes about communication between visits or care coordination activities.

Documentation Tips: Building a Solid Foundation for G2211

Medicare introduced G2211 in 2021, but new changes in the 2025 Medicare Physician Fee Schedule (MPFS) final rule make it easier to bill. Here’s what practices need to know:

  • Eligible Encounters: Do not bill G2211 alone. Report it with office or outpatient E/M codes 99202–99205 and 99211–99215.
  • Expanded Use: You can now bill G2211 even when the same-day visit includes:
    •  A preventive exam (initial or annual wellness visit),
    •  A vaccine administration, or
    •  Another Medicare Part B preventive service.
  • Modifier 25: Medicare lifted the prohibition against using G2211 with an E/M service appended with modifier 25.
  • Eligible Providers: Physicians and qualified nonphysician practitioners (NPPs) can bill G2211 if providing an eligible E/M service.
  • Frequency: There are no frequency limits. You can report G2211 as often as appropriate based on documentation.
  • Payer Policies: Medicare Part B and many Medicare Advantage plans now reimburse for G2211. However, Medicaid and commercial payers are not required to. Always check individual payer contracts and fee schedules.
  • Exclusions: Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) cannot bill it.

Your documentation should align well with G2211 expectations when routinely including these elements.

Best Practices: How to Integrate G2211 Successfully

To capture G2211 accurately and consistently, practices should:

1. Train Providers and Coders

Offer targeted training to both providers and coding staff. Providers must document the relationship complexity within their notes, while coders must recognize eligible encounters and understand payer-specific policies.

2. Optimize EHR Templates and Workflows

Update EHR templates to prompt documentation of ongoing management efforts. Review workflows to ensure that team members consistently capture long-term relationship elements.

3. Conduct Regular Audits and Provide Feedback

Update EHR templates to prompt documentation of ongoing management efforts. Review workflows to ensure that team members consistently capture long-term relationship elements.

Conclusion: Recognizing the True Value of Continuous Care

Procedure code G2211 represents an essential shift in how Medicare values the time and expertise providers invest in long-term patient care. By staying informed, documenting appropriately, and training teams effectively, healthcare organizations can use G2211 to:

  • Accurately capture the complexity of care,
  • Secure appropriate reimbursement and
  • Strengthen patient-provider relationships that drive better health outcomes.

As healthcare systems evolve, leveraging opportunities like G2211 will be essential for operational success and high-quality care. 

[This article was inspired by a February 3, 2025, post on  AAPC by Stephani Scott (https://www.aapc.com/blog/91931-bill-g2211-with-confidence-and-modifier-25/). Oasis used additional research, including Google's Gemini Advanced AI and OpenAI's ChatGPT models.]

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Oasis Medical Solutions is a trusted partner for healthcare practices, offering comprehensive services and support for Azalea Health's suite of electronic health record (EHR) and practice management solutions. Focusing on personalized implementation, training, and ongoing support, Oasis Medical Solutions helps clients optimize their technology to improve efficiency and deliver exceptional patient care.

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Oasis Medical Solutions is a healthcare technology company that helps medical practices streamline their operations and maximize revenue. We specialize in providing Electronic Health Records (EHR) systems and related services, including practice management software, billing solutions, and consulting.

With a focus on personalized service and customized solutions, Oasis aims to empower healthcare providers to navigate the complexities of the healthcare industry and focus on delivering quality patient care.

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