Decoding G2211: when to use the add-on code

G2211 is a “visit complexity” add-on code physicians can use to get credit for the work they do keeping patients healthy on an ongoing basis. But Medicare’s rules make it somewhat difficult to know when it applies.

What is G2211?

Physicians use G2211 on office visit and home and residence codes to indicate that they have a long-term relationship with the patient and “serve as the continuing focal point for all needed health care services.” The Centers for Medicare & Medicaid Services (CMS) emphasizes that it isn’t about the condition being treated, but the longitudinal relationship with the patient. Therefore, most primary care evaluation and management (E/M) visits generally qualify for G2211. But CMS usually doesn’t allow G2211 when modifier 25 is used on the E/M service.

An exception to the modifier-25 rule

The exception is for office visits and Medicare covered preventive services, such as Part B preventive services, annual wellness visits (AWVs), or immunization administrations. When physicians combine an AWV, vaccination, or other preventive service with a problem-oriented E/M office visit on the same day and use modifier 25, they may also report G2211.

G2211 with E/M and other services

However, the modifier 25 rule means that physicians can’t use G2211 if they perform a procedure during an E/M visit. For example, if a physician removed a lesion on the day of an E/M office visit and used modifier 25, they could not report G2211.

But there are other services that can be done during an E/M visit without disqualifying G2211 because they don’t require modifier 25. For example, physicians who perform blood draws during an E/M visit can report venipuncture code 36415 with the E/M visit code and can usually add G2211 as well. Venipuncture isn’t paid from the Medicare Physician Fee Schedule, it is paid under the clinical lab schedule, and it usually isn’t necessary to add modifier 25 to an E/M service when 36415 is done on the day of a visit for Medicare claims. Commercial payers may have an edit that requires modifier 25 on an office visit with venipuncture, but it is not a National Correct Coding Initiative edit.

For more on when to use or not use G2211, see the 2025 FPM article, “G2211 Update and Infographic: When to Use the Visit Complexity Add-On Code.

— Betsy Nicolletti, a speaker and consultant in coding education, billing, and accounts receivable

Posted on Oct. 10, 2026