11/30/2023    Michael G. Warshaw, DPM, CPC

G2211

Query: G2211

I have been trying to educate myself on G2211.
Does anyone have any scenarios when this might be
appropriate to bill? I am not sure I understand
when this might apply to something a podiatrist
would see and treat.

Codingline Archive

Response: It is important to be aware that HCPCS
Level II code G2211 is not a primary code. It is
an add-on code.

HCPCS Level II code G2211 is defined as the
following: 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)
HCPCS Level II Code G2211 was first proposed by
CMS in 2021 as a way to compensate physicians for
the extra work required for coordination of care
for complex or serious conditions. Congress
mandated a delay in implementation of the code
until January 1, 2024.

The following information is from the 2024 Final
Rule which was released November 2, 2023:
1. This code is for practitioners who use E/M
services to report most of their services. CMS
believes that the valuations for office visit
codes don’t adequately reflect the cost of caring
for the complexity of certain kinds of visits. CMS
believes that the values don’t account “for the
resource costs associated with primary care and
other longitudinal care of complex patients.”
2. The goal of developing and paying for this
service is to pay clinicians to address needs with
consistency and continuity over long periods of
time. The payment is for the time, intensity and
practice expense of providing these services to
patients.
3. G2211 is an add-on code to office and other
outpatient services, 99202–99215.
4. CMS believes it will be used by primary care
and other specialties who treat a single, serious
condition or a complex condition with consistency
and continuity over a long period of time. CMS
emphasizes the longitudinal relationship between
the practitioner and the patient.
5. CMS will not allow G2211 to be used with an E/M
service if modifier 25 is appended to the E/M
service.

Based upon the above information, I feel that it
would be difficult to justify the use of HCPCS
Level II code G2211 in podiatry.

Finally, it is important to note that 1 RVU for
Medicare will be worth 32.74 in 2024. HCPCS Level
II code G2211 is worth 0.33 RVU. Just do the math.

Michael G. Warshaw, DPM, CPC, Lady Lake, FL

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