G2211 – 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.)

In 2019, the Centers for Medicare & Medicaid Services (CMS) created a new add-on Healthcare Common Procedure Coding System (HCPCS) code G2211 (previously referred to as GPC1X) to be billed with the office/outpatient evaluation and management (E/M) codes for the purposes of adjusting payment to account for additional costs incurred when providing E/M services beyond the typical resources involved. In the 2024 Medicare Physician Fee Schedule, CMS finalized separate payment for HCPCS add-on code G2211, allowing the use of the code for complex visits that are inherent to an office/outpatient E/M associated with care management services for treatment of patients with a single, serious condition, or complex condition.

The addition of this HCPCS code to the Medicare Physician Fee Schedule was the driving force behind the Medicare payment cuts for 2024 due to budget neutrality. CMS expects this code to be used with the E/M service about 38% of the time. ASA and other medical organizations were concerned that the addition of this new code may result in duplicative payments for physician work that is already captured in the other existing codes. CMS did not make it clear how this code is different from the other existing chronic care management codes.

You might be wondering if you are able to bill this new add-on code for your chronic pain services and collect additional payment. Starting January 1, 2024, you can report this code for ongoing medical care related to a patient’s single, serious condition, or complex condition. This code requires the longitudinal physician and patient relationship. Since this is an add-on code, you can’t bill it without the related E/M code. The documentation of the physician’s assessment and plan for the treatment along with the patient’s diagnoses can support medical necessity. Furthermore, HCPCS G2211 can be used for a new or established patient if you have or will establish an ongoing relationship to manage the patient’s condition. However, code G2211 should not be reported with modifier 25 unless the E/M service is significant and separately identifiable from the other services you perform on the same date.

For example, pain physicians who treat complex chronic pain conditions, such as cancer pain, neuropathic pain, and complex regional pain syndrome (CRPS), are able to report HCPCS code G2211 along with the E/M codes to report pain management.