CMS Releases Updated Guidance for Using G2211: Complex Patient Care Add-on Code

Beginning January 1, the Centers for Medicare & Medicaid Services (CMS) expanded its billing policy for HCPCS code 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).  

The new policy, finalized in the 2025 Medicare Physician Fee Schedule final rule, allows payment for G2211 in certain circumstances even if modifier -25 is used to indicate that an evaluation and management (E/M) service is significant and separately identifiable from other allowed Part B services when performed on the same date. Prior to this change, G2211 was not payable when a claim had the -25 modifier appended to the E/M service. The allowed services include Part B preventive services, immunization administration, and annual wellness visits.

CMS released guidance to assist providers, and other stakeholders in appropriate billing for G2211. The guidance includes a MLN Matters article and a list of allowed Part B preventative services that are captured under the policy.