On this page · 6 sections
| Code | Description | Notes |
|---|---|---|
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 home or residence or office/outpatient evaluation and management service, new or established.) | Descriptor refined for 2026 |
Part 1 of 5
What G2211 pays for
The complexity G2211 describes isn't in the clinical condition. It is the cognitive load of being responsible for the patient over time. Every visit has to work for today's problem and also keep a long-term relationship of trust.
Concept map
G2211
Visit complexity add-on
Relationship (either one)
- Continuing focal point for all needed care (e.g. primary care)
- Ongoing care for a single, serious or complex condition (e.g. HIV, sickle cell disease)
Base codes
99202–99205Office, new99211–99215Office, established99341–99350Home or residence (from 2026)
Modifier 25
- Not paid with modifier 25 for a procedure
- Paid with an AWV/IPPE, vaccine administration or Part B preventive service (office from 2025, home from 2026)
Documentation
- Reason for the visit: medically necessary
- Diagnoses, assessment and plan
- Claim history for this patient–practitioner pair
- Other services billed
Done: What G2211 pays for
Part 2 of 5
Timeline
- 2021
Code created
Payment delayed by the Consolidated Appropriations Act, 2021 (status: bundled).
- 1 Jan 2024
Separately payable
Status changed to active for office/outpatient visits.
- 1 Jan 2025
Modifier 25 exception
Paid with a modifier 25 office visit when an AWV/IPPE, vaccine administration or Part B preventive service is on the same date.
- 1 Jan 2026
Home or residence visits
Paid with 99341, 99342, 99344, 99345, 99347–99350, including the modifier 25 exception.
99341–99350
Who can bill it
- Any specialty. The code isn't limited to primary care.
- Any level of the base visit, from 99211 to 99215 and from 99341 to 99350.
- The relationship decides. CMS says the most important information is the relationship between practitioner and patient. Either the practitioner is the focal point for all needed services, or is part of ongoing care for a single serious or complex condition.
Done: Timeline and who can bill
Part 3 of 5
CMS examples
Sinus congestion with the patient's PCP
A patient's primary care practitioner is the continuing focal point for all their care. The patient comes in for sinus congestion. The PCP has to choose between conservative treatment and antibiotics. They also have to keep the patient's trust, so the patient will follow advice later (for example, on a vaccine at the next visit). Weighing all that makes even a simple visit complex.
Bill: office E/M (for example 99213) + G2211.
HIV follow-up with the infectious disease physician
The patient admits to missing several doses of HIV medication. The ID physician has to stress adherence while keeping the patient comfortable enough to be honest next time. If the patient hides missed doses, a working medicine might be switched for no reason. The ID physician isn't the focal point for all care, but HIV is a single, serious condition and the relationship is ongoing.
Bill: office E/M + G2211.
Done: CMS examples
Part 4 of 5
Modifier 25: paid or denied?
Claim A
AWV + problem visit (office)
G0439Paid99214-25PaidG2211AWV exceptionPaid
Modifier 25 is for the AWV, a preventive service, so G2211 is payable (since 2025).
Claim B
Skin biopsy + problem visit (office)
11102Paid99213-25PaidG2211procedure with -25Denied
Modifier 25 is for a procedure, so Medicare doesn't pay G2211.
Claim C
Home visit + flu shot (2026)
99349-25PaidG0008PaidG2211new for home visits in 2026Paid
Vaccine administration is an exception, and from 2026 it applies to home visits too.
Calculator: G2211 check
Medicare rules, 2026G2211 can be reported
992xx+G2211
Source: Claims Processing Manual ch. 12 §30.6.19 (rev. May 2026); MLN006764.
Done: Modifier 25
Part 5 of 5
Practice
Done: Practice