Transitioning from G2211 to B1 and B2 modifiers: a 2027 Medicare payment change that could affect your paycheck
The 2027 Medicare Physician Fee Schedule final rule includes a number of changes, many of which will be explored in greater detail in the upcoming FPM annual update. However, the transition from G2211 to the new B1 and B2 modifiers deserves more immediate attention because of a potentially unintended consequence for physician compensation.
A quick refresher
G2211 is an add-on code intended to recognize the additional cognitive work and complexity associated with providing ongoing, longitudinal care. It has been particularly beneficial to primary care physicians, although it is not limited to primary care.
Under the current fee schedule, G2211 carries 0.33 work relative value units (RVUs) and may be reported with eligible office and outpatient E/M visits. It generally cannot be reported when the E/M service includes a -25 modifier, with exceptions for certain preventive services, including Annual Wellness Visits, vaccine administration, and other qualifying Medicare Part-B preventive services.
What’s changing
Beginning Jan. 1, 2027, the Centers for Medicare and Medicaid Services (CMS) is eliminating G2211 and replacing it with two modifiers:
- B1: Increases Medicare payment for an eligible E/M encounter by 16%.
- B2: Increases Medicare payment for an eligible E/M encounter by 32% for eligible clinicians participating in a Medicare Shared Savings Program (MSSP) accountable care organization (ACO) or the Long-term Enhanced ACO Design (LEAD) model.
The new modifiers generally follow the same eligibility and reporting restrictions as G2211.
For many primary care practices, this is good news. Rather than providing a fixed payment for G2211, the new modifiers provide a percentage increase in reimbursement that scales with the underlying E/M service. Even after accounting for the reduction in the Medicare conversion factor, eligible E/M encounters may generate increased revenue. For practices participating in MSSP or LEAD, the potential increase is even greater.
An important distinction: Increased practice revenue may not mean increased physician compensation
When I recently shared these updates with a colleague, she pointed out an unintended consequence that deserves attention. She typically sees six Medicare patients per day in her practice. Under her current employment contract, the elimination of G2211 could result in an annual compensation reduction of more than $18,000.
Why? The new B1 and B2 modifiers increase Medicare reimbursement through payment adjustments; they do not provide separately attributable work RVUs like G2211 did.
This distinction matters enormously for physicians whose compensation is based on work RVU productivity.
Under the previous system, an eligible encounter could generate additional work RVUs through G2211. Beginning in 2027, the practice may receive a 16% or 32% increase in Medicare payment for that encounter, but the physician may no longer receive the corresponding productivity credit under a conventional work RVU-based compensation formula.
In other words, the practice can make more money while the physician makes less.
This is particularly concerning for employed physicians whose contracts tie compensation directly to work RVU production without accounting for changes in Medicare reimbursement methodology.
The financial impact will vary depending on the number of eligible Medicare encounters, the physician’s compensation formula, and the contractual treatment of add-on services and payment adjustments. However, even physicians who see relatively few Medicare patients could experience a meaningful reduction.
What to do before Jan. 1, 2027
If you are employed under an RVU-based compensation agreement, now is the time to review your contract.
Specifically, consider these steps:
- Determine whether your compensation formula currently includes the work RVUs associated with G2211.
- Identify how the elimination of G2211 and implementation of B1 and B2 will affect your productivity calculations.
- Discuss appropriate adjustments to employment agreements so that changes in Medicare reimbursement methodology do not inadvertently reduce physician compensation.
- Work with your billing and EHR teams to ensure templates, charge capture, and coding workflows are updated for the new modifiers.
For reference, CMS has mapped modifiers B1 and B2 to values comparable to RVUs at each E/M level (Table 1).
Table 1. Modifier B1 and B2 adjusted RVUs
| CPT code | Total RVUs | Total RVUs with B1 | Total RVUs with B2 |
|---|---|---|---|
| 99202 | 2.27 | 2.42 | 2.57 |
| 99203 | 3.48 | 3.74 | 3.99 |
| 99204 | 5.21 | 5.63 | 6.04 |
| 99205 | 6.91 | 7.47 | 8.03 |
| 99211 | 0.74 | 0.77 | 0.8 |
| 99212 | 1.77 | 1.88 | 1.99 |
| 99213 | 2.82 | 3.03 | 3.24 |
| 99214 | 4.02 | 4.33 | 4.63 |
| 99215 | 5.62 | 6.07 | 6.52 |
| 99341 | 1.49 | 1.65 | 1.81 |
| 99342 | 2.42 | 2.68 | 2.95 |
| 99344 | 4.41 | 4.87 | 5.33 |
| 99345 | 6.19 | 6.81 | 7.43 |
| 99347 | 1.42 | 1.56 | 1.71 |
| 99348 | 2.4 | 2.64 | 2.88 |
| 99349 | 3.88 | 4.27 | 4.66 |
| 99350 | 5.69 | 6.27 | 6.84 |
Source: CMS. CY 2027 Physician Fee Schedule final rule modifier B1 and B2 adjusted RVUs. Nov. 10, 2026. https://www.cms.gov/files/zip/cy-2027-pfs-final-rule-mod-b1-b2-adjusted-rvus-updated-11-10-2026.zip
Bottom line
The transition from G2211 to B1 and B2 may represent a welcome increase in Medicare reimbursement for many practices. However, physicians should not assume that increased reimbursement automatically translates into increased compensation.
Take the time to understand the changes now. Your 2027 paycheck may depend on it.
— Samuel L. Church, MD, MPH, CPC, FAAFP
Posted on November 12, 2026