FAQs about the G2211 charge

Background on the G2211 charge…

The G2211 charge was first added to the American medical billing system in 2021 by Medicare as a mechanism to cover the additional time and costs associated with longitudinal (whole person) care during a primary care encounter, or an encounter by a specialist providing consistent care over long periods of time.  Due to budgetary constraints, reimbursement was postponed until Jan. 1, 2024, when it finally became officially part of the Medicare Fee Schedule.  Now that it is funded by Medicare, many commercial insurers are also adding this as a contracted service.

What is the G2211 charge?

The 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 condition or a complex condition (Add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established).

Why was the G2211 created?

The G2211 charge was created in recognition of the time and work involved in providing comprehensive care, as compared to either treating a single issue or single organ system.  Prior to the G2211, reimbursement for treatment of a condition was roughly the same between an urgent care provider and a primary care provider, despite the fact that PCPs provide more comprehensive care, adding both time and complexity.

What is the reimbursement for the G2211?

Medicare and other insurers are reimbursing approximately $16 per visit for the G2211, with patient’s out of pocket costs typically following the patient’s specific cost-sharing plan (through either copays, coinsurance, and/or deductible) as determined by their insurance policy.

Will I be charged a G2211 at every visit?

Virtually all primary care offices will be implementing the G2211 charge, and will likely appear on any problem focused office visits seen by their PCP.    There are some restrictions on when the G2211 can be billed.  It can’t be billed during a Well Exam or a Procedure.  Further, it can only be billed by physicians who provide comprehensive care.  As explained by Medicare, the most important factor in determining if the G2211 charge can be added is by understanding the nature of the relationship between the patient and physician, when they are acting as the focal point for all ongoing healthcare.