By: Christopher A. Parrella, Esq., CPC, CHC, CPCO
Parrella Health Law, Boston, Ma.

CMS has introduced a significant update regarding the Office and Outpatient Evaluation and Management (E/M) Visit Complexity Add-on Code G2211, effective January 1, 2024. This code is crucial for healthcare providers, including hospitals, physicians, suppliers, and others billing Medicare Administrative Contractors (MACs). Here are the key takeaways:

G2211 Overview

This code is designed for office and outpatient E/M visits across various specialties. It acknowledges the complexity in managing patients with continuous healthcare needs or serious conditions.

Billing Requirements

Providers need to understand the correct application of HCPCS code G2211, along with the necessary documentation and its impact on patient coinsurance and deductibles.

Code Implementation

The criteria for billing G2211 include scenarios where a practitioner is continuously managing complex health conditions.

Modifier 25 Guidelines

G2211 must be reported alongside an O/O E/M visit and is not payable with modifier 25.

Documentation and Compliance

Proper documentation is essential to justify the medical necessity of the O/O E/M visit when billing G2211.

Reimbursement and Coverage

The code is paid using the Physician Fee Schedule, subject to patient coinsurance and deductibles.

This CMS update is a crucial development in recognizing the resources required for complex patient care. Healthcare providers should refer to the full CMS document for comprehensive information.

At Parrella Health Law, we are committed to guiding our clients through the complexities of healthcare law with expert advice and comprehensive solutions. If you have any questions about this blog post or require assistance with healthcare defense and compliance matters, please don’t hesitate to contact us. We are ready to speak with you or respond to any emails sent to 857-328-0382.

Christopher Parrella, ESQ, CPC, CHC, CPCO, is the founding partner of Parrella Health Law in Boston, Mass. The firm focuses exclusively on healthcare defense and compliance matters. Chris also travels the country on behalf of a wide range of healthcare organizations, lecturing on a variety of health care enforcement and compliance topics. Chris is one of a handful of health care attorney’s that are also Certified Professional Coders (CPC) and is a member of the AAPC’s National Legal Advisory Board and Ethics Committee.  He is also a Certified Professional Compliance Officer (CPCO) and Certified in Health Care Compliance (CHC.)