The Centers for Medicare & Medicaid Services (CMS) has released guidance on the billing requirements for G2211 to ensure that coding and billing staff know when to bill the code, the necessary documentation requirements, and the associated patient coinsurance and deductibles..
In the 2024 Medicare Physician Fee Schedule Final Rule, CMS finalized coding and reimbursement for evaluation and management add-on code G2211 to capture the work caring for medically complex patients. In the guidance, CMS highlights that the code is intended to capture ongoing medical care related to a patient’s single, serious condition, or complex condition and/or the relationship between a patient and a physician and the inherent complexity in managing that relationship. CMS’ guidance includes examples to illustrate correct usage of the code.
Depending on the level of the evaluation and management service reported (99202-99205, 99211-99215), a provider may see visit reimbursement increase from 7.3% to 69%, according to an ASCO summary of the proposed rule. ASCO’s Coverage and Reimbursement page includes a resource to guide our members on the usage of and additional requirements for reporting the G2211 code.
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