G2211 add-on code: What it is and when to use it
G2211 is a tool for aligning payment with the realities of primary care.
The AAFP closely monitors the implementation of G2211 and updates this page as CMS releases new information.
The care you provide your patients is complex and comprehensive. The G2211 add-on code helps ensure you’re paid more accurately for that work. You can use this add-on code in conjunction with office and outpatient evaluation and management (E/M) codes to receive additional payment for the high-value visits you provide.
What is G2211?
Healthcare Common Procedure Coding System (HCPCS) add-on code G2211 reflects the time, intensity and practice expenses involved when physicians provide office or outpatient visits that build ongoing relationships with patients and address most of their health care needs with consistency and continuity over time.
CMS developed G2211 to better reflect the time and resources required for complex, ongoing primary care.
The 2024 national Medicare allowable amount is $16.05.
CMS code descriptor: 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.)
When to use G2211
HCPCS code G2211 became payable starting January 1, 2024. It can be reported with new and established patient office or outpatient E/M services.
Use G2211 when you are the continuing focal point for all or most of the patient’s health care needs. According to CMS, the nature of the patient-physician relationship determines whether the add-on code should be billed.
G2211 applies only to office and outpatient E/M codes (CPT 99202–99215).
Do not use G2211 when your relationship with the patient is discrete, routine or time-limited. For instance, a physician who sees a patient once for an acute concern should not report G2211 if they have not assumed, or do not intend to assume, responsibility for the patient’s ongoing care with consistency and continuity over time.
FPM has published guidance and an infographic to help you navigate G2211 use (updated 2025).
How to start billing for G2211
Before you begin billing, make sure your EHR and billing systems are updated to reflect the 2024 Medicare Physician Fee Schedule.
G2211 billing steps
Verify G2211 has been added to your system. Practice management or billing and coding staff can typically assist with this.
Inform patients there may be an additional charge on their bill because deductible and coinsurance apply.
Report HCPCS code G2211 with office visits in which you have assumed, or intend to assume, responsibility for the patient’s ongoing medical care.
Educate your administrative and coding teams about the importance of G2211.
Why it matters
Studies show primary care office visits are more complex than those conducted by other specialties. Primary care physicians manage multiple acute and chronic conditions, deliver preventive services, counsel patients, and address behavioral and social needs, all within short visits. G2211 helps account for this additional complexity and cost.
Medicare officials agree that current E/M payment rates do not fully reflect the comprehensive, whole-person care that primary care physicians provide.
Existing E/M coding is better at capturing procedural services than the cognitive, longitudinal services at the heart of primary care. On average, a primary care physician caring for Medicare patients coordinates care with 229 other physicians across 117 practices.
Member-exclusive G2211 resources
AAFP members can access these tools to advocate for payment of G2211, track private payer coverage and navigate claims.
Member resources
Guide to verifying coverage and navigating denials: Use this guide to contact payers about G2211 policies or address inappropriate claim denials.
Letter template – Physician to payer: Use this template to request private payer coverage and payment of G2211.
Letter template – Physician to employer: Use this template to encourage employers to advocate for payer coverage.
Template – G2211 private payer coverage matrix: Track payer policies, resources and contact details for G2211 coverage.
G2211 advocacy talking points: Use these talking points to explain the purpose of G2211 and its importance in reflecting primary care complexity.
Not a member?
Frequently asked questions
The MLN Matters® article How to use the office & outpatient evaluation and management visit complexity add-on code G2211 states: “Document the reason for billing the office and outpatient E/M visit. The visits themselves would need to be medically reasonable and necessary for the practitioner to report G2211. Also, the documentation would need to illustrate medical necessity of the office and outpatient E/M visit. [CMS hasn’t] required additional documentation. [CMS'] medical reviewers may use the medical record documentation to confirm the medical necessity of the visit and accuracy of the documentation of the time you spent.”
Supporting documentation may include:
Information in the medical record or claims history for a patient-practitioner combination, such as diagnoses
The practitioner’s assessment and plan for the visit
Other service codes billed
Private payers (including commercial and Medicare Advantage) and Medicaid are not required to cover or pay separately for G2211, and their policies will vary. Review your contracts and speak with your provider relations representatives about adding G2211 to your fee schedule.
The AAFP strongly advocates that private payers cover and pay for G2211 across all lines of business. Learn more about this effort in Decoding G2211: Myths versus facts.
CMS has not explicitly defined “single, serious condition or complex condition,” but it has cited HIV and sickle cell disease as examples.
Their guidance emphasizes the importance of the longitudinal relationship serving as the continuing focal point for all of the patient’s health care needs.
The complexity captured by G2211 is not tied to the condition itself. CMS clarifies that G2211 applies to services that enable practitioners to build longitudinal relationships with all patients—not just those with chronic or high-risk diseases—and to address the majority of patients’ health care needs over long periods of time.
No. Since FQHCs and RHCs are paid an encounter rate rather than being paid based on patient complexity, G2211 will be bundled into the FQHC prospective payment system rate and the RHC all-inclusive rate.
Yes. G2211 may be reported under the primary care exception as long as the code’s requirements are satisfied.
No. G2211 is not restricted by specialty. CMS emphasizes that it can be reported by physicians whose E/M visits represent:
Ongoing, comprehensive care that serves as the continuing focal point for all needed services
AND/OR
Care for a patient’s single, serious or complex condition
There are no frequency limitations on G2211. It can be billed with any office E/M visit if the code’s requirements are met.
Yes. G2211 is subject to Medicare’s deductible and coinsurance.
Yes. G2211 is on the Medicare list of telehealth services (ZIP) and can be billed with office visit E/M services (CPT 99202–99215) provided via telehealth.
Yes. CMS includes two examples in the MLN Matters article How to use the office & outpatient evaluation and management visit complexity add-on code G2211 (see pages 2–3 of the article).
Beginning in 2025, Medicare will pay for G2211 when the base E/M code is appended with modifier 25 and provided on the same day as an annual wellness visit, vaccine administration or any Medicare Part B preventive service.
To learn more about proper modifier 25 use, see:
Seven quick tips for using modifier 25 (April 2023)
Combining a wellness visit with a problem-oriented visit: A coding guide (Jan./Feb. 2022)
Getting paid for screening and assessment services (Nov./Dec. 2017)
AMA: Setting the record straight on proper use of modifier 25 (Aug. 2023)
CMS has published the following materials to explain G2211 and its use:
Medicare G2211: Answers to frequently asked questions
MM13473: How to use the office & outpatient evaluation and management visit complexity add-on code G2211 (released Jan. 18, 2024; revised April 29, 2025)
CR13473: Guidance for the implementation of the office and outpatient (O/O) evaluation and management (E/M) visit complexity add-on code G2211 (released Jan. 18, 2024)
Related resources
E/M coding FAQs: Understand how to properly document and code for E/M services.
Safeguard G2211: Congress must enact long-term Medicare payment reforms. Use the AAFP’s Speak Out tool to urge lawmakers to modernize payment.
How to use modifier 25: Learn more about modifier 25 and how it affects G2211.
Getting Paid blog: Follow FPM’s Getting Paid blog for payment updates and tips on accurate coding and billing.